PDF下载 ( 2111 KB)
Value of early admission scoring systems in predicting the severity and prognosis of acute pancreatitis
-
摘要:
目的通过纳入入院早期（24 h内）即可对急性胰腺炎严重程度及预后进行评估的较全面的评分系统,筛选出早期预测最有价值的评分系统。方法回顾性收集2016年9月-2019年9月昆明医科大学第二附属医院消化内科收治的254例急性胰腺炎患者资料,分为轻症急性胰腺炎组（MAP组）、中度重症急性胰腺炎组（MSAP组）和重症急性胰腺炎组（SAP组）,分析3组患者的一般资料、合并症及入院早期评分系统（包括BISAP评分、SIRS评分、MEWS评分、PANC3评分、HAPS评分、CTSI评分、SPS评分）的差异,并将各早期评分系统进行急性胰腺炎严重程度及预后预测价值的比较。符合正态分布的计量资料多组间比较采用方差分析;非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验。计数资料组间比较采用χ2检验或Fisher确切概率法。绘制受试者工作特征曲线（ROC曲线）,比较ROC曲线下面积（AUC）。结果 3组患者住院天数及住院费用比较,差异有统计学意义（H值分别为48. 82、76. 93,P值均<0. 05）;合并症中,3组患者在是否合并肺部感染、胰腺坏死、多器官...
Abstract:Objective To screen out the scoring system with the highest predictive value by analyzing the comprehensive scoring systems which can assess the severity and prognosis of acute pancreatitis in the early stage( within 24 hours) after admission. Methods A retrospective analysis was performed for the clinical data of 254 patients with acute pancreatitis who were admitted to Department of Gastroenterology,The Second Affiliated Hospital of Kunming Medical University,from September 2016 to September 2019,and they were divided into mild acute pancreatitis( MAP) group,moderate-severe acute pancreatitis( MSAP) group,and severe acute pancreatitis( SAP) group.The three groups were compared in terms of general data,comorbidities,and scores of early admission scoring systems,including BISAP score,SIRS score,MEWS score,PANC3 score,HAPS score,CTSI score,and SPS score,and these scoring systems were compared in terms of their value in predicting the severity and prognosis of acute pancreatitis. An analysis of variance was used for comparison of normally distributed continuous data between groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The receiver operating characteristic( ROC) curve was plotted and the area under the ROC curve( AUC) was compared. Results The SAP group had a significantly longer length of hospital stay and significantly higher hospital costs than the other two groups( H = 48. 82 and 76. 93,both P<0. 05). As for comorbidities,there were significant differences in the presence or absence of pulmonary infection,pancreatic necrosis,multiple organ dysfunction syndrome( MODS),and death between the three groups( H = 64. 84,98. 19,53. 09,and 8. 09,all P < 0. 05). As for the early scoring systems,there were significant differences between the three groups in BISAP score,SIRS score,MEWS score,HAPS score,CTSI score,and SPS score( H = 93. 19,21. 24,23. 99,16. 57,67. 09,and 33. 95,all P < 0. 05). The early scoring systems were further compared in terms of the severity of pancreatitis and complications based on the ROC curve,and it was found that BISAP score had the highest value in predicting SAP and pulmonary infection within 24 hours after admission,with sensitivities of 86. 10% and 51. 20%,respectively,and specificities of 81. 70% and 83. 50%,respectively,at the cut-off value of >2. CTSI score had the highest value in predicting pancreatic necrosis,with a sensitivity of 82. 70% and a specificity of 89. 10% at the cut-off value of > 3. In terms of MODS,both HAPS and BISAP scores had good predictive value,with sensitivities of 63. 70% and 75. 00%,respectively,and specificities of 90. 00%and 76. 10%,respectively. Conclusion Different scoring systems have their own advantages in predicting the severity and complications of pancreatitis in the early stage,among which BISAP score has a high value in predicting SAP,pancreatitis with pulmonary infection,and MODS,CTSI score has a high value in predicting pancreatic necrosis,and HAPS score has a high value in excluding MODS in the early stage.
-
Key words:
- pancreatitis /
- early scoring system /
- prognosis
-
[1] FORSMARK CE,BAILLIE J,AGA Institute Clinical Practice and Economics Committee,et al. AGA Institute technical review on acute pancreatitis[J]. Gastroenterology,2007,132(5):2022-2044. [2] PAPACHRISTOU GI,CLERMONT G,SHARMA A,et al. Risk and markers of severe acute pancreatitis[J]. Gastroenterol Clin North Am,2007,36(2):277-296. [3] WU BU,BANKS PA. Clinical management of patients with acute pancreatitis[J]. Gastroenterology,2013,144(6):1272-1281. [4] BANKS PA,BOLLEN TL,DERVENIS C,et al. Classification of acute pancreatitis--2012:Revision of the Atlanta classification and definitions by international consensus[J]. Gut,2013,62(1):102-111. [5] LU JH,NIU YY,ZHANG Y,et al. Application value of MEWS scoring assessment system in severe acute pancreatitis patients[J]. China Med Herald,2018,15(16):162-165.(in Chinese)卢俊红，牛玉英，张颖，等．早期预警评分在急诊科急性胰腺炎患者护理中的应用[J]．中国医药导报，2018,15(16):162-165. [6] LENG F,YANG L,CHANG ZG,et al. Classification of acute pancreatitis-2012:International consensus on classification and definition revision of Atlanta[J]. J Clin Hepatol,2013,29(4):322-328.(in Chinese)冷芳，杨力，常志刚，等．急性胰腺炎分类———2012:亚特兰大分类和定义修订的国际共识[J]．临床肝胆病杂志，2013,29(4):322-328. [7] Pancreas Study Group,Chinese Society of Gastroenterology,Chinese Medical Association; Editorial Board of Chinese Journal of Pancreatology; Editorial Board of Chinese Journal of Digestion. Chinese guidelines for the management of acute pancreatitis(Shenyang,2019)[J]. J Clin Hepatol,2019,35(12):2706-2711.(in Chinese)中华医学会消化病学分会胰腺疾病学组，《中华胰腺病杂志》编委会，《中华消化杂志》编委会．中国急性胰腺炎诊治指南(2019年，沈阳)[J]．临床肝胆病杂志，2019,35(12):2706-2711. [8] XIAN LN,YANG YZ,CHEN W,et al. The application value of chemokine MIP-1α，MIP-1βand APACHEⅡscore in the severity and prognosis of acute pancreatitis[J]. Trauma and Crit Medicine,2018,6(1):14-17.(in Chinese)冼丽娜，杨远征，陈伟，等．巨噬细胞炎性蛋白-1α、巨噬细胞炎性蛋白-1β与急性生理和慢性健康状况评分在急性胰腺炎严重程度及预后中应用价值[J]．创伤与急危重病医学，2018,6(1):14-17. [9] BROWN A,JAMES-STEVENSON T,DYSON T,et al. The panc 3 score:A rapid and accurate test for predicting severity on presentation in acute pancreatitis[J]. J Clin Gastroenterol,2007,41(9):855-858. [10] TSUJI Y,TAKAHASHI N,TSUTOMU C. Pancreatic perfusion CT in early stage of severe acute pancreatitis[J]. Int J Inflam,2012:497386. [11] WU BU,JOHANNES RS,SUN X,et al. The early prediction of mortality in acute pancreatitis:A large population-based study[J]. Gut,2008,57(12):1698-1703. [12] GAO W,YANG HX,MA CE. The value of BISAP score for predicting mortality and severity in acute pancreatitis:A systematic review and Meta-analysis[J]. PLo S One,2015,10(6):e0130412. [13] WANG AJ,XU S,HONG JB,et al. The comparison of different clinical scoring systems for predicting prognosis in acute pancreatitis based on the revised Atlanta classification[J].Chin J Intern Med,2013,52(8):668-671.(in Chinese)汪安江，徐思，洪军波，等．新亚特兰大分类下不同评分标准预测急性胰腺炎预后的价值比较[J]．中华内科杂志，2013,52(8):668-671. [14] WANG Y,ATTAR BM. Comment on“Comparison of BISAP,Ranson,MCTSI,and APACHE II in Predicting Severity and Prognoses of Hyperlipidemic Acute Pancreatitis in Chinese Patients”[J]. Gastroenterol Res Pract,2017,2017:1426486. [15] ZHENG JM,GAO JC,ZHAO HW,et al. Comparison of four scoring systems in the evaluation of prognosis of acute pancreatitis[J]. Tianjin Med J,2015,43(2):217-220.(in Chinese)郑吉敏，高俊茶，赵红伟，等．四种评分系统对急性胰腺炎预后评估价值的比较[J]．天津医药，2015,43(2):217-220. [16] HARSHIT KUMAR A,SINGH GRIWAN M. A comparison of APACHE II,BISAP,Ranson's score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification[J]. Gastroenterol Rep(Oxf),2018,6(2):127-131. [17] BALTHAZAR EJ,RANSON JH,NAIDICH DP,et al. Acute pancreatitis:Prognostic value of CT[J]. Radiology,1985,156(3):767-772. [18] Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis[J]. Pancreatology,2013,13(4 Suppl 2):e1-e15. [19] HE WH,ZHU Y,ZHU Y,et al. Comparison of multifactor scoring systems and single serum markers for the early prediction of the severity of acute pancreatitis[J]. J Gastroenterol Hepatol,2017,32(11):1895-1901. [20] LANKISCH PG,WEBER-DANY B,HEBEL K,et al. The harmless acute pancreatitis score:A clinical algorithm for rapid initial stratification of nonsevere disease[J]. Clin Gastroenterol Hepatol,2009,7(6):702-705; quiz 607. [21] ZHANG YY,HUANG H,LU ML,et al. Comparative study of different scoring systems on the judgment of the condition and prognosis of acute pancreatitis[J]. Chin J Gastroenter Hepatol,2018,27(1):25-29.(in Chinese)张映媛，黄华，路明亮，等．不同评分系统对判断急性胰腺炎病情及预后的比较研究[J]．胃肠病学和肝病学杂志，2018,27(1):25-29. [22] KUO DC,RIDER AC,ESTRADA P,et al. Acute pancreatitis:What's the score?[J]. J Emerg Med,2015,48(6):762-770. -
本文二维码
计量
- 文章访问数: 863
- HTML全文浏览量: 31
- PDF下载量: 182
- 被引次数: 0
下载:
