APACHE-O评分系统对急性重症胰腺炎的预测价值

The predictive value of combination of APACHE-Ⅱ score and an obesity score (APACHE-O) for severe acute pancreatitis

目的探讨APACHE-O评分系统(APACHE-II+肥胖指标评分)对急性重症胰腺炎的预测价值。方法2004年1月1日至2006年1月1日间急性胰腺炎患者142例,根据体重指数(body mass index,BMI)分组,把BMI≥26kg/m归为肥胖组,BMI<26kg/m归为非肥胖组。比较两组患者病情严重程度及并发症等发生情况。分别计算入院24h内APACHE-Ⅱ和APACHE-O评分在不同临界点对急性重症胰腺炎预测的敏感性、特异性、阳性预测值、阴性预测值和准确性,绘制APACHE-II和APACHE-O评分受试者工作曲线(receive-operating curves,ROC)。通过比较ROC的曲线下面积(area under the curve,AUC)来比较两评分系统的预测准确性。结果肥胖组中急性重症胰腺炎患者比例显著高于非肥胖组(P<0.05),肥胖组中胰腺坏死、胰腺假性囊肿及肺功能衰竭发生率显著高于非肥胖组(P<0.05)。取临界点为8时,APACHE-Ⅱ和APACHE-O评分对急性重症胰腺炎预测的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为78.9%,85.4%,45.5%,96.3%,84.5%和78.9%,82.1%,40.5%,96.2%,81.7%。APACHE-Ⅱ和APACHE-O评分的ROC的AUC分别为0.864和0.870,提示APACHE-O评分对重症胰腺炎预测价值稍高于APACHE-Ⅱ评分。结论肥胖型急性胰腺炎患者预后更差。与入院时A-PACHE-Ⅱ评分比较,APACHE-O评分对急性重症胰腺炎的预测价值略高于APACHE-II,为理想的急性重症胰腺炎预测系统。

Objective To investigate the predictive value of combination of APACHE-Ⅱ score and an obesity score （APACHE-O） for severe acute pancreatitis（SAP）. Methods Data were collected prospectively from 142 consecutive patients with acute pancreatitis （AP） to allow calculation of the APACHE-Ⅱ score and body mass index （BMI）. Patients were divided into normal（BMI〈26 kg/m） and obese （BMI≥26 kg/m） groups according to BMI. The severity and the rates of complications in two groups mentioned were compared respectively. Receiver-operating curves （ROC） for prediction of SAP were calculated using admission APACHE- Ⅱ and APACHE-O scores within 24 hours. The area under the curve （AUC） was determined for comparing predictive accuracy. The diagnostic accuracy of individual clinical scores for severe outcome was assessed using sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV） and accuracy by a range of cut-off values. Results The percentage of patients with SAP in obese group was higher than that in normal group.The rates of occurence of pancreatic necrosis, pancreatic pseudocyst and respiratory failure in obese group were higher than those in normal group. At cut-off of 8, APACHE-Ⅱ and APACHE-O had sensitivity 78.9% and 78.9%, specificity 82.1% and 85.4 %, positive predictive value 40.5% and 45.5%, negative predictive value 96.2% and 96.3%, and overall accuracy 81.7% and 84.5%, respectively. The AUC of ROC of APACHE-Ⅱ score and APACHE-O score were 0.864 and 0.870,respectively, suggesting that APACHE-O score increased the predictive value of APACHE- Ⅱ. Conclusions Our study results suggest that obesity increases the severity of AP. Using APACHE-O score within 24 hours at admission may improve slightly the predictive accuracy for sevevere outcome in AP compared with APACHE- Ⅱ.