Abstract
Background Severe acute pancreatitis (SAP) can cause various complications. Septic shock is a relatively common and serious complication that causes uncontrolled systemic inflammatory response syndrome, which is one of the main causes of death. This study aimed to develop a nomogram for predicting the overall survival of SAP patients during the initial 24 hours following admission. Materials and Methods All the data utilized in this study were obtained from the MIMIC-III (Medical Information Mart for Intensive Care III) database. The data were analyzed using multivariate Cox regression, and the performance of the proposed nomogram was evaluated based on Harrell's concordance index (C-index) and the area under the receiver operating characteristic curve (AUC). The clinical value of the prediction model was tested using decision-curve analysis (DCA). The primary outcomes were 28-day, 60-day, and 90-day mortality rates. Results The 850 patients included in the analysis comprised 595 in the training cohort and 255 in the validation cohort. The training cohort consisted of 353 (59.3%) males and 242 (40.7%) females with SAP. Multivariate Cox regression showed that weight, sex, insurance status, explicit sepsis, SAPSII score, Elixhauser score, bilirubin, anion gap, creatinine, hematocrit, hemoglobin, RDW, SPO2, and respiratory rate were independent prognostic factors for the survival of SAP patients admitted to an intensive care unit. The predicted values were compared using C-indexes, calibration plots, integrated discrimination improvement, net reclassification improvement, and DCA. Conclusions We have identified some important demographic and laboratory parameters related to the prognosis of patients with SAP and have used them to establish a more accurate and convenient nomogram for evaluating their 28-day, 60-day, and 90-day mortality rates.
Highlights
Severe acute pancreatitis (SAP) can cause various complications
It is a critical disease with a high fatality rate, and especially in severe acute pancreatitis (SAP) the tissues release various factors including activated trypsin, a large number of cytokines, and inflammatory mediators, which aggravate the inflammatory necrosis of the pancreas and can even involve lesions in adjacent organs and tissues
Prognostic Nomogram for 28-Day, 60-Day and 90-Day Mortality. e results of the multivariate regression model presented in Table 2 were used to establish a nomogram (Figure 2). e nomogram contained all of important independent factors predicting 28-day, 60-day, and 90-day mortality in the training cohort. e nomogram indicates that hemoglobin is the most important factor affecting prognosis, and it includes sex, insurance status, explicit sepsis, Elixhauser score, weight, bilirubin, anion gap, creatinine, hematocrit, hemoglobin, RDW, heart rate, respiratory rate, and SPO2
Summary
Severe acute pancreatitis (SAP) can cause various complications. Septic shock is a relatively common and serious complication that causes uncontrolled systemic inflammatory response syndrome, which is one of the main causes of death. is study aimed to develop a nomogram for predicting the overall survival of SAP patients during the initial 24 hours following admission. Acute pancreatitis (AP) is a clinically common condition that is characterized by sudden inflammation of the pancreas and the release of a series of digestive enzymes, leading to local tissue damage and multiple organ dysfunction syndrome (MODS) [1]. It is a critical disease with a high fatality rate, and especially in severe acute pancreatitis (SAP) the tissues release various factors including activated trypsin, a large number of cytokines, and inflammatory mediators, which aggravate the inflammatory necrosis of the pancreas and can even involve lesions in adjacent organs and tissues. Literature reviews have found that factors such as age, RDW, WBC, albumin, ALT, MODS, and SPO2 are significantly associated with a higher risk of death in SAP patients [6, 7]
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