Clinical value of biochemical markers in predicting organ failure in acute pancreatitis induced by hyperlipidemia

Abstract

Objective To investigate the early predictive value of several commonly used biochemical markers for predicting persistent organ failure (POF) in patients with hyperlipidemic acute pancreatitis (HLAP). Methods Clinical data of 157 patients with HLAP within 72 hours after the onset of first attack who were admitted to the Dept. of Gastroenterology in Changhai Hospital from January 2015 to December 2017 were retrospectively analyzed, including 106 cases without POF (non POF group) and 51 cases with POF (POF group). Hct, BUN, Cr, APACHE Ⅱ and BISAP were recorded within 24 hours after admission. Receiver-operating characteristic (ROC) curve was drawn to calculate area under the ROC curve (AUC) and evaluate the performance of Hct, BUN, Cr, APACHE Ⅱ and BISAP scores in predicting HLAP complicated with POF, which was compared by DeLong test. Results Values of BUN, Cr, APACHE Ⅱ and BISAP were significantly higher in HLAP patients with POF than those without POF [(10.30±7.43) vs (5.34±2.26)mmol/L, (165.31±123.93) vs (65.61±20.82)μmol/L, (10.22±6.22) vs (4.61±2.99) points, (2.61±0.87) vs (1.42±1.07) points], and the differences were all statistically significant (all P<0.05), whereas Hct was not significantly different between the two groups. The AUC of Cr and BUN for predicting POF was 0.77(95% CI, 0.69-0.86) and 0.71 (95% CI, 0.61-0.81), respectively, and the optimum predictive Cut-off values were 130 μmol/L and 8.95 mmol/L, respectively. The sensitivity was 53%, and the specificity was 99% and 94%; the accuracy was 84% and 81%; negative predictive value was 81%, and positive predictive value was 96% and 82%. DeLong test showed that predictive performance of BUN and Cr was not statistically different from that of APACHE Ⅱ and BISAP. Conclusions Cr≥130 μmol/L and BUN≥8.95 mmol/L can be used clinically to predict the presence of POF in HLAP, and the predictive efficacy were comparable to APACHE Ⅱ and BISAP. Key words: Pancreatitis; Hyperlipidemias; Multiple organ failure; Scoring system; Hematocrit; Creatinine; Urea nitrogen