Abstract
IntroductionThe available prognostic scoring systems for severe acute pancreatitis (SAP) have limitations that restrict their clinical value. The aim of this study was to develop a simple model (score) that could rapidly identify those at risk for SAP.MethodsWe derived a risk model using a retrospective cohort of 700 patients by logistic regression and bootstrapping methods. The discriminative power of the risk model was assessed by calculating the area under the receiver operating characteristic curves (AUC). The classification and regression tree (CART) analysis was used to create risk categories. The model was internally validated by a tenfold cross-validation and externally validated in a separate prospective cohort of 194 patients.ResultsThe incidence of SAP was 9.7% in the derivation cohort and 9.3% in the validation cohort. A prognostic score (We denoted it as the SABP score), ranging from 0 to 10, consisting of systemic inflammatory response syndrome, serum albumin, blood urea nitrogen and pleural effusion, was developed by logistic regression and bootstrapping analysis. Patients could be divided into three risk categories according to total SABP score based on CART analysis. The mean probability of developing SAP was 1.9%, 12.8% and 41.6% in patients with low (0–3), moderate (4–6) and high (7–10) SABP score, respectively. The AUCs of prognostic score in tenfold cross-validation was 0.873 and 0.872 in the external validation.ConclusionOur risk prediction score may assist physicians in predicting the development of SAP.
Highlights
The available prognostic scoring systems for severe acute pancreatitis (SAP) have limitations that restrict their clinical value
Inclusion and exclusion criteria Patients with acute pancreatitis admitted to the First Affiliated Hospital of Wenzhou Medical University (Wenzhou City, Zhejiang Province, China) within 72 h of symptom onset from January 2012 to December 2015 were retrospectively included in the derivation cohort [16]
Our results showed a positive association between an initial increased blood urea nitrogen (BUN) level at admission and the development of SAP in acute pancreatitis
Summary
The available prognostic scoring systems for severe acute pancreatitis (SAP) have limitations that restrict their clinical value. Identification of high-risk patients on admission may help physicians to select those patients who would benefit the most from close surveillance, or aggressive intervention [5]. Early identification of patients who have a high probability of developing SAP in the emergency room may benefit from close surveillance, aggressive critical care and early treatment [5, 6]. Clinicians need to identify those patients who do not respond to early resuscitation or display SAP for possible transfer to specialist care or a pancreatitis centre if available [2, 6]. The ability to identify patients at risk of SAP early in the disease course helps in designing mechanistic studies or clinical trials for targeted intervention [3]
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