Application of acute gastrointestinal injury grading system in assessing the severity of acute pancreatitis

Abstract

Objective To explore the predictive value of acute gastrointestinal injury(AGI) grading system in assessing the severity, infectious pancreatic necrosis and death of patients with moderate severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). Methods The clinical data of 344 patients with MSAP or SAP admitted in Changhai Hospital Affiliated to Navy Medical University from June 2011 to June 2015 were collected. ROC curve was used and the area under ROC curve (AUC) was calculated. The predictive value of AGI grade for the severity, infectous pancreatic necrosis and death was compared with those of different clinical scores(APACHEⅡ score, MCTSI and Marshal score). Results Of 344 patients, 81 patients were classified into high AGI grade group (Grade Ⅲ, Ⅳ), while 263 patients were in low AGI grade group(Grade Ⅰ, Ⅱ). The mortality and the number of patients with organ failure were obviously higher in high AGI grade group than those in low AGI grade group (25/81 vs 0/263, 36/45 vs 32/231), and the difference was statistically significant (all P<values 0.001). AUC of high AGI grade for predicting patients′ death and infectious pancreatic necrosis was 0.944(95% CI 0.916-0.972) and0.779(95% CI 0.723-0.836), respectively, which was higher than those of APACHEⅡ and Marshall score. Conclusions AGI grading system can be applied to better assess the severity of acute pancreatitis, and its predictive value for death and infectious pancreatic necrosis was higher than that of APACHEⅡ, MCTSI and Marshall score. Key words: Pancreatitis, acute necrotizing; Acute gastrointestinal injury; Forecasting