qSOFA评分联合红细胞分布宽度与血钙比值对重症急性胰腺炎的早期识别及Nomogram图的构建

Early Recognition of Severe Acute Pancreatitis by qSOFA Score Combined with Red Blood Cell Distribution Width-to-Serum Calcium Ratio and Nomogram Construction

目的探讨快速序贯器官衰竭评分(quick sequential organ failure assessment,qSOFA)联合红细胞分布宽度与血钙比值(red blood cell distribution width-to-serum calcium ratio,RDC)对重症急性胰腺炎(severe acute pancreatitis,SAP)的预测价值。方法回顾性分析2018年6月~2022年10月徐州医科大学附属医院收治的319例急性胰腺炎患者的临床资料,根据病情严重程度分为非SAP组(n=260)和SAP组(n=59)。所有患者均于入院24h内进行血样采集并检测相应血液学指标,并于24h内进行qSOFA与急性胰腺严重床旁指数(bedside index for severity in acute pancreatitis,BISAP)评分。比较两组间的临床资料并进行Logistic回归分析危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估qSOFA评分、RDC及两者联合评分对SAP的预测效能,并与BISAP评分进行比较。结果多因素Logistic回归分析发现,RDC(OR=4.111,95%CI:2.053~8.231,P<0.05)和qSOFA(OR=9.732,95%CI:3.974~23.832,P<0.05)高评分是SAP的独立危险因素。联合评分及BISAP评分预测SAP的曲线下面积(area under the curve,AUC)分别为0.915(95%CI:0.872~0.959,P<0.001)、0.839(95%CI:0.782~0.896,P<0.001),敏感度分别为93.2%、66.1%,特异性分别为85.0%、86.2%。结论qSOFA评分、RDC均可预测SAP的发生,两者联合评分对SAP发生的预测效能更高,可用于早期识别SAP的发生并指导早期干预。

Objective To explore the predictive value of the quick sequential organ failure assessment(qSOFA)score combined with red blood cell distribution width-to-serum calcium ratio(RDC)for severe acute pancreatitis(SAP).Methods Clinical data of 319 patients with acute pancreatitis admitted to the Affiliated Hospital of Xuzhou Medical University from June 2018 to October 2022 were retrospectively analyzed,and they were divided into non-SAP group(n=260)and SAP group(n=59).Blood samples were collected and hematologic parameters were measured within 24h of admission.The qSOFA score and bedside index for severity in acute pancreatitis(BISAP)score were performed within 24h of admission.The clinical data between the two groups were compared and the risk factors were analyzed by Logistic regression.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of qSOFA score,RDC and their combined score in predicting SAP.Results Multivariate Logistic regression analysis indicated that RDC(OR=4.111,95%CI:2.053-8.231,P<0.05)and qSOFA score(OR=9.732,95%CI:3.974-23.832,P<0.05)were independent risk factors for SAP.The area under the curve(AUC)for the combined score and BISAP score for predicting SAP were 0.915(95%CI:0.872-0.959,P<0.001),0.839(95%CI:0.782-0.896,P<0.001),and the sensitivity were 93.2%,66.1%,and the specificity were 85.0%,86.2%.Conclusion Both qSOFA score and RDC can predict the occurrence of SAP,and the RDC combined with qSOFA score for predicting SAP has more effectively predictive value,which can be used to early identify the occurrence of SAP,and guide early intervention.