入院时无害性急性胰腺炎评分可预测轻症急性胰腺炎

Harmless acute pancreatitis score on admission can accurately predict mild acute pancreatitis

目的评价入院时无害性急性胰腺炎评分(HAPS)对轻症急性胰腺炎(MAP)的预测效能。方法前瞻性纳入2016年1月~2017年8月连续就诊于四川大学华西医院的急性胰腺炎(AP)患者,计算入院时HAPS评分。根据HAPS评分将AP患者分为无害性AP组(HAPS>2)和非无害性AP组(HAPS≤2),比较两组患者的临床结局。以2012年修订的亚特兰大分级定义MAP,绘制受试者工作特征曲线(ROC),获得曲线下面积(AUC),特异性,敏感性,阳性预测值和阴性预测值。结果本研究共纳入703例患者,与HAPS评分预测为无害性AP组(n=182)的患者相比,非无害性AP组(n=521)患者的临床结局更差(P<0.001)。本研究纳入MAP患者共计359例(51.1%),入院时的HAPS评分预测MAP的特异性为97.7%(95%CI:95.4-99.0),敏感性为48.2%(95%CI:42.9-53.3),阳性预测值为95.6%(95%CI:91.5-98.1),阴性预测值为64.1%(95%CI:59.8-68.2),AUC为0.749(95%CI:0.72-0.78)。结论入院时HAPS评分预测MAP的效能较高。

Objective To evaluate the efficacy of harmless acute pancreatitis score(HAPS)on admission for predicting mild acute pancreatitis(MAP).Methods We prospectively collected the data from consecutive AP patients admitted to West China Hospital between January,2016 and August,2017,and HAPS scores were calculated on admission.The clinical outcomes of the patients with harmless AP(HAPS>2)and those with non-harmless AP(HAPS≤2)were compared.MAP was defined based on the severity classification of 2012 Revised Atlanta guidelines.The area under the curve(AUC)of the receiver-operator characteristic curve(ROC),specificity,sensitivity,positive predictive value(PPV)and negative predictive value(NPV)of HAPS on admission for predicting MAP were analyzed.Results Of the 703 patients with AP analyzed,182 were predicted to have harmless AP and 521 to have non-harmless AP,and the patients in the latter group had significantly worse clinical outcomes(P<0.001).The total number of patients with MAP was 359 in the study.The specificity,the sensitivity,the PPV and NPV of HAPS on admission for predicting MAP was 97.7%(95%CI:95.4-99.0),48.2%(95%CI:42.9-53.3),95.6%(95%CI:91.5-98.1)and 64.1%(95%CI:59.8-68.2),respectively,and the AUC was 0.749(95%CI:0.72-0.78).Conclusion HAPS score on admission can accurately predict MAP.