Hao Yixiu, Feng Jiajun, He Wenjuan, Wu Yongshun, Ma Ying, Xu Honggang
Department of Radiology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China.
J Comput Assist Tomogr. 2025 Aug 6. doi: 10.1097/RCT.0000000000001791.
Hypertriglyceridemic acute pancreatitis (HTG-AP) is a distinct subtype of acute pancreatitis with a wide spectrum of clinical severity, ranging from mild to moderately severe or severe disease. Timely identification of patients at higher risk is essential for informing early clinical decisions and improving outcomes. However, reliable tools specifically designed to stratify HTG-AP severity remain limited.
To develop and validate a predictive model for distinguishing mild from moderately severe/severe hypertriglyceridemic acute pancreatitis (HTG-AP) using routine clinical and imaging parameters.
This retrospective study included 106 patients diagnosed with HTG-AP at Guangzhou First People's Hospital from January 2018 to April 2023. Patients were categorized into mild (HTG-MAP) and moderately severe/severe (HTG-MSAP/SAP) groups based on the revised Atlanta classification. Clinical data, laboratory results, and imaging findings, including peak C-reactive protein (CRP), serum calcium levels, and Modified CT Severity Index (MCTSI) scores, were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of disease severity. Model performance was assessed through 10-fold cross-validation and bootstrap calibration.
Among the 106 patients (median age: 38 y; 82.1% male), 46 had HTG-MAP and 60 had HTG-MSAP/SAP. Multivariate analysis identified peak CRP (OR: 1.0082, P=0.011), serum calcium (OR: 0.05, P=0.014), and MCTSI score ≥6 (OR: 4.91, P=0.008) as independent predictors of severe disease. The final logistic regression model demonstrated excellent discrimination, with an AUC of 0.900 in the overall cohort and a mean cross-validated AUC of 0.87. Calibration was satisfactory (Hosmer-Lemeshow P=0.774), and overall diagnostic accuracy reached 84.91%.
The proposed model, incorporating peak CRP, serum calcium, and MCTSI score, effectively distinguishes between HTG-MAP and HTG-MSAP/SAP. Compared with conventional scoring systems such as Bedside Index for Severity in Acute Pancreatitis (BISAP), it demonstrates superior specificity and overall diagnostic accuracy, providing clinicians with a practical tool for risk stratification and clinical decision-making in HTG-AP.
高甘油三酯血症性急性胰腺炎（HTG-AP）是急性胰腺炎的一种独特亚型，临床严重程度范围广泛，从轻度到中度严重或重度疾病。及时识别高危患者对于指导早期临床决策和改善预后至关重要。然而，专门用于对HTG-AP严重程度进行分层的可靠工具仍然有限。
使用常规临床和影像学参数开发并验证一种预测模型，以区分轻度与中度严重/重度高甘油三酯血症性急性胰腺炎（HTG-AP）。
这项回顾性研究纳入了2018年1月至2023年4月在广州市第一人民医院诊断为HTG-AP的106例患者。根据修订的亚特兰大分类，将患者分为轻度（HTG-MAP）和中度严重/重度（HTG-MSAP/SAP）组。分析临床数据、实验室结果和影像学表现，包括C反应蛋白（CRP）峰值、血清钙水平和改良CT严重程度指数（MCTSI）评分。进行单因素和多因素逻辑回归分析以确定疾病严重程度的独立预测因素。通过10倍交叉验证和自助法校准评估模型性能。
在106例患者（中位年龄：38岁；82.1%为男性）中，46例患有HTG-MAP，60例患有HTG-MSAP/SAP。多因素分析确定CRP峰值（OR：1.0082，P=0.011）、血清钙（OR：0.05，P=0.014）和MCTSI评分≥6（OR：4.91，P=0.008）为严重疾病的独立预测因素。最终的逻辑回归模型显示出出色的区分能力，在整个队列中的AUC为0.900，平均交叉验证AUC为0.87。校准效果良好（Hosmer-Lemeshow P=0.774），总体诊断准确率达到84.91%。
所提出的模型纳入了CRP峰值、血清钙和MCTSI评分，能够有效区分HTG-MAP和HTG-MSAP/SAP。与急性胰腺炎严重程度床边指数（BISAP）等传统评分系统相比，它具有更高的特异性和总体诊断准确率，为临床医生提供了一种用于HTG-AP风险分层和临床决策的实用工具。
