摘要
Existing predictor systems of severe pancreatitis are cumbersome and can requ ire up to 48 hr to complete. This study aimed to determine whether useful likeli hood ratios exist for the prediction of severe pancreatitis, corresponding to va rious ranges of admission hematocrit. A retrospective cohort of 200 patients adm itted with acute pancreatitis was identified. Likelihood ratios were calculated for a priori defined hematocrit ranges. Using multivariate logistic regression, initial hematocrit was evaluated as a predictor of severe pancreatitis as define d a priori by local and/or systemic complications (Atlanta criteria, 1992). Plan ned subgroup analysis was performed on those with a hematocrit >50% , stratifie d by 24- hr hematocrit. Fourteen patients (7% ) developed severe pancreatitis. Likelihood ratios were 0.45, 0.70, and 7.5 for hematocrit ranges of≤ 45,45.1- 49.9, and ≥ 50% , respectively. Hematocrit (as increases by 5% ) was a signi ficant predictor of severe pancreatitis (odds ratio [OR] = 2.8; P = 0.001), leng th of stay (P < 0.0001), necrosis (OR = 3.9; P = 0.001), and need for intensive care (OR 4.5; P = 0.002). The negative predictive value of the lowest range and positive predictive value of the highest range were 97% (95% Cl: 92- 99% ) and 37% (16- 62% ), respectively. Lack of normalization of hematocrit by 24 hr did not predict severe pancreatitis. Initial hematocrit appears to be an ear ly, simple, and useful predictor of severe pancreatitis. A normal 24- hr hemato crit does not appear to alter the prediction made by the initial hematocrit.
Existing predictor systems of severe pancreatitis are cumbersome and can requ ire up to 48 hr to complete. This study aimed to determine whether useful likeli hood ratios exist for the prediction of severe pancreatitis, corresponding to va rious ranges of admission hematocrit. A retrospective cohort of 200 patients adm itted with acute pancreatitis was identified. Likelihood ratios were calculated for a priori defined hematocrit ranges. Using multivariate logistic regression, initial hematocrit was evaluated as a predictor of severe pancreatitis as define d a priori by local and/or systemic complications (Atlanta criteria, 1992). Plan ned subgroup analysis was performed on those with a hematocrit >50% , stratifie d by 24- hr hematocrit. Fourteen patients (7% ) developed severe pancreatitis. Likelihood ratios were 0.45, 0.70, and 7.5 for hematocrit ranges of≤ 45,45.1- 49.9, and ≥ 50% , respectively. Hematocrit (as increases by 5% ) was a signi ficant predictor of severe pancreatitis (odds ratio [OR] = 2.8; P = 0.001), leng th of stay (P < 0.0001), necrosis (OR = 3.9; P = 0.001), and need for intensive care (OR 4.5; P = 0.002). The negative predictive value of the lowest range and positive predictive value of the highest range were 97% (95% Cl: 92- 99% ) and 37% (16- 62% ), respectively. Lack of normalization of hematocrit by 24 hr did not predict severe pancreatitis. Initial hematocrit appears to be an ear ly, simple, and useful predictor of severe pancreatitis. A normal 24- hr hemato crit does not appear to alter the prediction made by the initial hematocrit.
