四种评分系统在急诊老年急性胰腺炎患者严重程度评估中的对比研究

A Contrst Study on 4 Scoring Systems in Predicting the Severity of Acute Pancreatitis in Emergency Elderly

目的探讨BISAP、MEWS、SIRS标准和HAPS四种简易评分系统在预测老年重症急性胰腺炎中的价值,并对其预测效能进行对比,以寻求更有效的适合急诊老年急性AP患者的早期预警评分标准。方法收集2014年1月—2017年5月复旦大学附属金山医院急诊科住院的204例老年急性胰腺炎患者的临床资料及入院BISAP、MEWS、SIRS标准和HAPS评分,比较四种评分系统与老年患者急性胰腺炎病情严重程度的相关性,并通过ROC曲线分析比较四种评分系统预测病情严重程度的准确度。结果 204例老年急性胰腺炎患者中,轻中度胰腺炎组172例(84.31%),重症胰腺炎(SAP)组32例(15.69%)。BISAP评分、MEWS评分和SIRS标准与疾病严重程度相关(P<0.001);HAPS评分与疾病严重程度相关性较差(P>0.05);BISAP评分、MEWS评分、SIRS标准和HAPS评分的ROC曲线下面积分别为0.852、0.715、0.738和0.562,BISAP评分和MEWS评分比较时ROC曲线下面积差异具有统计学意义(P<0.01),BISAP评分和SIRS标准比较R0C曲线下面积差异具有统计学意义(P<0.05),MEWS评分和SIRS标准比较R0C曲线下面积差异无统计学意义(P>0.05)。结论BISAP评分、MEWS评分和SIRS标准与老年急性胰腺炎病情严重程度相关性较好,其中BISAP评分对重症胰腺炎的预测最为准确,BISAP≥3分提示SAP。BISAP评分更适用于急诊老年急性胰腺炎患者的早期预后评估。

Objective To explore the values of 4 scoring systems (BISAP,MEWS,SIRS and HAPS) in predicting the severity of acute pancreatitis (AP) in emergency elderly in order to define a more effective early warning scoring criteria. Methods The clinical data and the scores of BISAP,MEWS,SIRS and HAPS of 204 elderly with AP admitted to the emergency room of Jinshan Hospital during the period from Jan.,2014 to May,2017 were collected and analyzed;the correlation between the scoring systems and the severity of AP was studied;ROC curves were applied in the comparison of prediction accuracy among the 4 systems.Results 204 elderly with AP were enrolled: 172 with mild-moderate acute pancreatitis (84.31%) and 32 with severe acute pancreatitis (SAP)(15.69%);BISAP,SIRS and MEWS scores were correlated with the severity of AP (P<0.001) while HAPS scores was in poorer correlation (P>0.05);the AUC of BISAP,MEWS, SIRS and HAPS was 0.852,0.715,0.738 and 0.562 respectively,and there existed statistical difference in AUC between BISAP and MEWS scoring system (P<0.01) and between BISAP and SIRS scoring system (P<0.05);no significant difference was found in AUC between MEWS and SIRS scoring system (P>0.05).Conclusions BISAP,SIRS and MEWS are in good correlation to the severity of AP in emergency elderly;BISAP provides the most accurate prediction of the severity of AP;scores greater than or equal to 3 in BISAP indicates the occurrence of severe AP;BISAP is of better application in early prognosis prediction of emergency elderly with AP.