Red cell distribution width: A predictor of the severity of hypertriglyceridemia-induced acute pancreatitis

BACKGROUND Compared with patients with other causes of acute pancreatitis,those with hypertriglyceridemia-induced acute pancreatitis(HTG-AP)are more likely to develop persistent organ failure(POF).Therefore,recognizing the individuals at risk of developing POF early in the HTG-AP process is a vital for improving outcomes.Bedside index for severity in acute pancreatitis(BISAP),a simple parameter that is obtained 24 h after admission,is an ideal index to predict HTG-AP severity;however,the suboptimal sensitivity limits its clinical application.Hence,current clinical scoring systems and biochemical parameters are not sufficient for predicting HTG-AP severity.AIM To elucidate the early predictive value of red cell distribution width(RDW)for POF in HTG-AP.METHODS In total,102 patients with HTG-AP were retrospectively enrolled.Demographic and clinical data,including RDW,were collected from all patients on admission.RESULTS Based on the Revised Atlanta Classification,37(33%)of 102 patients with HTG-AP were diagnosed with POF.On admission,RDW was significantly higher in patients with HTG-AP and POF than in those without POF(14.4%vs 12.5%,P<0.001).The receiver operating characteristic curve demonstrated a good discrim-inative power of RDW for POF with a cutoff of 13.1%,where the area under the curve(AUC),sensitivity,and specificity were 0.85,82.4%,and 77.9%,respectively.When the RDW was≥13.1%and one point was added to the original BISAP to obtain a new BISAP score,we achieved a higher AUC,sensitivity,and specificity of 0.89,91.2%,and 67.6%,respectively.CONCLUSION RDW is a promising predictor of POF in patients with HTG-AP,and the addition of RDW can promote the sensitivity of BISAP.

Body-mass index correlates with severity and mortality in acute pancreatitis: A meta-analysis

BACKGROUND Obesity rates have increased sharply in recent decades. As there is a growing number of cases in which acute pancreatitis(AP) is accompanied by obesity, we found it clinically relevant to investigate how body-mass index(BMI) affects the outcome of the disease.AIM To quantify the association between subgroups of BMI and the severity and mortality of AP.METHODS A meta-analysis was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis(PRISMA) Protocols. Three databases(PubMed, EMBASE and the Cochrane Library) were searched for articles containing data on BMI, disease severity and mortality rate for AP. Englishlanguage studies from inception to 19 June 2017 were checked against our predetermined eligibility criteria. The included articles reported all AP cases with no restriction on the etiology of the disease. Only studies that classified AP cases according to the Atlanta Criteria were involved in the severity analyses. Odds ratios(OR) and mean differences(MD) were pooled using the random effects model with the DerSimonian-Laird estimation and displayed on forest plots. The meta-analysis was registered in PROSPERO under number CRD42017077890.RESULTS A total of 19 articles were included in our meta-analysis containing data on 9997 patients. As regards severity, a subgroup analysis showed a direct association between AP severity and BMI. BMI < 18.5 had no significant effect on severity;however, BMI > 25 had an almost three-fold increased risk for severe AP in comparison to normal BMI(OR = 2.87, 95%CI: 1.90-4.35, P < 0.001). Importantly,the mean BMI of patients with severe AP is higher than that of the non-severe group(MD = 1.79, 95%CI: 0.89-2.70, P < 0.001). As regards mortality, death rates among AP patients are the highest in the underweight and obese subgroups. A BMI < 18.5 carries an almost two-fold increase in risk of mortality compared to normal BMI(OR = 1.82, 95%CI: 1.32-2.50, P < 0.001). However, the chance of mortality is almost equal in the normal BMI and BMI 25-30 subgroups. A BMI >30 results in a three times higher risk of mortality in comparison to a BMI < 30(OR = 2.89, 95%CI: 1.10-7.36, P = 0.026).CONCLUSION Our findings confirm that a BMI above 25 increases the risk of severe AP, while a BMI > 30 raises the risk of mortality. A BMI < 18.5 carries an almost two times higher risk of mortality in AP.

Balthazar computed tomography severity index is superior to Ranson criteria and APACHE Ⅱ scoring system in predicting acute pancreatitis outcome

AIM: Acute pancreatitis (AP) is a process with variable involvement of regional tissues or organ systems.Multifactorial scales included the Ranson, Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ) systems and Balthazar computed tomography severity index (CTSI).The purpose of this review study was to assess the accuracy of CTSI, Ranson score, and APACHE Ⅱ score in course and outcome prediction of AP.METHODS: We reviewed 121 patients who underwent helical CT within 48 h after onset of symptoms of a first episode of AP between 1999 and 2003. Fourteen inappropriate subjects were excluded; we reviewed the 107 contrastenhanced CT images to calculate the CTSI. We also reviewed their Ranson and APACHE Ⅱ score. In addition, complications,duration of hospitalization, mortality rate, and other pathology history also were our comparison parameters.RESULTS: We classified 85 patients (79%) as having mild AP (CTSI ＜5) and 22 patients (21%) as having severe AP (CTSI ≥5). In mild group, the mean APACHE Ⅱ score and Ranson score was 8.6±1.9 and 2.4±1.2, and those of severe group was 10.2±2.1 and 3.1±0.8, respectively. The most common complication was pseudocyst and abscess and it presented in 21 (20%) patients and their CTSI was 5.9±1.4. A CTSI ≥5 significantly correlated with death,complication present, and prolonged length of stay.Patients with a CTSI ≥5 were 15 times to die than those CTSI ＜5, and the prolonged length of stay and complications present were 17 times and 8 times than that in CTSI ＜5,respectively.CONCLUSION: CTSI is a useful tool in assessing the severity and outcome of AP and the CTSI ≥5 is an index in our study. Although Ranson score and APACHE Ⅱ score also are choices to be the predictors for complications,mortality and the length of stay of AP, the sensitivity of them are lower than CTSI.

Clinical significance of melatonin concentrations in predicting the severity of acute pancreatitis

AIM: To assess the value of plasma melatonin in pre-dicting acute pancreatitis when combined with the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and bedside index for severity in acute pancreatitis (BISAP) scoring systems. METHODS: APACHEⅡ and BISAP scores were calculated for 55 patients with acute physiology (AP) in the first 24 h of admission to the hospital. Additionally, morning (6:00 AM) serum melatonin concentrations were measured on the first day after admission. According to the diagnosis and treatment guidelines for acute pancreatitis in China, 42 patients suffered mild AP (MAP). The other 13 patients developed severe AP (SAP). A total of 45 healthy volunteers were used in this study as controls. The ability of melatonin and the APACHEⅡ and BISAP scoring systems to predict SAP was evaluated using a receiver operating characteristic (ROC) curve. The optimal melatonin cutoff concentration for SAP patients, based on the ROC curve, was used to classify the patients into either a high concen-tration group (34 cases) or a low concentration group (21 cases). Differences in the incidence of high scores, according to the APACHEⅡ and BISAP scoring sys- tems, were compared between the two groups. RESULTS: The MAP patients had increased melatonin levels compared to the SAP (38.34 ng/L vs 26.77 ng/L) (P = 0.021) and control patients (38.34 ng/L vs 30.73 ng/L) (P = 0.003). There was no significant difference inmelatoninconcentrations between the SAP group and the control group. The accuracy of determining SAP based on the melatonin level, the APACHEⅡ score and the BISAP score was 0.758, 0.872, and 0.906, respectively, according to the ROC curve. A melatonin concentration ≤ 28.74 ng/L was associated with an increased risk of developing SAP. The incidence of high scores (≥ 3) using the BISAP system was significantly higher in patients with low melatonin concentration (≤ 28.74 ng/L) compared to patients with high melatonin concentration (> 28.74 ng/L) (42.9% vs 14.7%, P = 0.02). The incidence of high APACHEⅡ scores (≥ 10) between the two groups was not significantly different. CONCLUSION: The melatonin concentration is closely related to the severity of AP and the BISAP score. Therefore, we can evaluate the severity of disease by measuring the levels of serum melatonin.

A body mass index ≥25 kg/m2 is associated with a poor prognosis in patients with acute pancreatitis: a study of Japanese patients

BACKGROUND:In Asian population, there is limited infor mation on the relevance between obesity and poor outcomes in acute pancreatitis(AP). The objective of this study was to examine the clinical impact of obesity based on body mass index(BMI) on prognosis of AP in Japanese patients.METHODS:A total of 116 patients with AP were enrolled in this study. Univariate and multivariate logistic regression analyses were performed to examine relations between BMI and patients’ outcomes. Additionally, to investigate whether including obesity as a prognostic factor improved the predic tive accuracy of a Japanese prognostic factor score(PF score)a receiver-operating characteristic(ROC) curve analysis of mortality was conducted.RESULTS:Multiple logistic regression analyses revealed that BMI ≥25 kg/m2was associated with a significant higher mor tality [odds ratio(OR)=15.8; 95% confidence interval(CI):1.1-227; P=0.043]. The area under the ROC curve(AUC) for the combination of PF score and BMI ≥25 kg/m2(AUC=0.881;95% CI:0.809-0.952) was higher than that for the PF score alone(AUC=0.820; 95% CI:0.713-0.927)(P=0.034).CONCLUSIONS:The negative impact of a high BMI on the prognosis of AP was confirmed in a Japanese population Including BMI ≥25 kg/m2 as an additional parameter to PF score enhanced the predictive value of the PF score for AP-related mortality.

Can ultrasound predict the severity of acute pancreatitis early by observing acute fluid collection?

INTRODUCTIONThe spectrum of acute pancreatitis (AP) ranges from a mild spontaneously resolved disorder to severe disease with mortality up to 20%-48.4%[1-3]. sAP is defined as the AP with organ failure and /or local complications which developed form acute fluid collection (AFC) including necrosis ,abscess , pseudocyst formation into or around the pancreas [4].

Extrapancreatic necrosis volume:A new tool in acute pancreatitis severity assessment?

BACKGROUND Many scores have been suggested to assess the severity of acute pancreatitis upon onset.The extrapancreatic necrosis volume is a novel,promising score that appears to be superior to other scores investigated so far.AIM To evaluate the discriminatory power of extrapancreatic necrosis volume to identify severe cases of acute pancreatitis.METHODS A total of 123 patients diagnosed with acute pancreatitis at Institute of Gastroenterology and Hepatology,St Spiridon Hospital between January 1,2017 and December 31,2019 were analyzed retrospectively.Pancreatitis was classified according to the revised Atlanta classification(rAC)as mild,moderate,or severe.Severity was also evaluated by computed tomography and classified according to the computed tomography severity index(CTSI)and the modified CTSI(mCTSI).The results were compared with the extrapancreatic volume necrosis to establish the sensitivity and specificity of each method.RESULTS The CTSI and mCTSI imaging scores and the extrapancreatic necrosis volume were highly correlated with the severity of pancreatitis estimated by the rAC(r=0.926,P<0.001 and r=0.950,P<0.001;r=0.784,P<0.001,respectively).The correlation of C-reactive protein with severity was positive but not as strong,and was not significant(r=0.133,P=0.154).The best predictor for the assessment of severe pancreatitis was the extrapancreatic necrosis volume[area under the curve(AUC)=0.993;95%confidence interval(CI):0.981-1.005],with a 99.5%sensitivity and 99.0%specificity at a cutoff value of 167 mL,followed by the mCTSI 2007 score(AUC=0.972;95%CI:0.946-0.999),with a 98.0%sensitivity and 96.5%specificity,and the CTSI 1990 score(AUC=0.969;95%CI:0.941-0.998),with a 97.0%sensitivity and 95.0%specificity.CONCLUSION Radiological severity scores correlate strongly and positively with disease activity.Extrapancreatic necrosis volume shows the best diagnostic accuracy for severe cases.

Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis

AIM: To determine factors related to disease severity, mortality and morbidity in acute pancreatitis. METHODS: One hundred and ninety-nine consecutive patients were admitted with the diagnosis of acute pancreatitis (AP) in a 5-year period (1998-2002). In a prospective design, demographic data, etiology, mean hospital admission time, clinical, radiological, biochemical findings, treatment modalities, mortality and morbidity were recorded. Endocrine insuffi ciency was investigated with oral glucose tolerance test. The relations between these parameters, scoring systems (Ranson, Imrie and APACHE Ⅱ) and patients' outcome were determined by using invariable tests and the receiver operating characteristics curve. RESULTS: One hundred patients were men and 99 were women; the mean age was 55 years. Biliary pancreatitis was the most common form, followed by idiopathic pancreatitis (53/ and 26/, respectively). Sixty-three patients had severe pancreatitis and 136 had mild disease. Respiratory rate > 20/min, pulse rate > 90/min, increased C-reactive protein (CRP), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels, organ necrosis > 30/ on computed tomography (CT) and leukocytosis were associated with severe disease. The rate of glucose intolerance, morbidity and mortality were 24.1/, 24.8/ and 13.6/, respectively. CRP > 142 mg/L, BUN > 22 mg/dL, LDH > 667 U/L, base excess > -5, CT severity index > 3 and APACHE score > 8 were related to morbidity and mortality. CONCLUSION: APACHE Ⅱ score, LDH, base excess and CT severity index have prognostic value and CRP is a reliable marker for predicting both mortality and morbidity.

Role of oxygen free radicals in patients with acute pancreatitis

The generation of oxygen free radicals has been implicated in the pathogenesis of experimental pancreatitis.The aim of this study was to determine the role of oxygen free radicals in patients with acute pancreatitis.METHODS: The plasma levels of C-reactive protein (CRP),lipid peroxide (LPO), myeloperoxidase (MPO) and superoxide dismutase (SOD) were measured in 13 patients with acute pancreatitis and 14 healthy volunteers.RESULTS: Among the patients with acute pancreatitis, there were higher plasma levels of LPO and MPO and lower SOD activity in patients with severe pancreatitis than in those with mild pancreatitis. However, there was no significant difference in the serum marker of oxidative stress no matter what the etiology was. The LPO level was especially correlated with the concentration of serum CRP and CT severity index.CONCLUSION: The oxygen free radicals may be closely associated with inflammatory process and the severity of acute pancreatitis. Especially, the concentration of plasma LPO is a meaningful index for determining the severity of the disease.

Organ dysfunction as a risk factor for early severe acute pancreatitis

We read with interest the review paper by Tao et al. on thetopic of early severe acute pancreatifis (EASP, defined as severeacute pancreatitis according to the Altanta criteria, with organdysfunction within 72 h after the start of symptoms) in a recentissue of the World Journal of Gastroenterology. It addressesan important problem in patients with severe acute pancreatitis,namely early organ dysfunction and its effect on outcomes.

急性胰腺炎患者血清CXC趋化因子配体10和CC类趋化因子22水平与疾病严重程度关系及临床诊断价值研究

目的:分析急性胰腺炎患者血清CXC趋化因子配体10(CXCL10)和CC类趋化因子22(CCL22)水平与疾病严重程度的关系及临床诊断价值。方法:选取急性胰腺炎患者102例,分为轻症组(轻症急性胰腺炎患者,47例)、中度重症组(中度重症急性胰腺炎患者,31例)和重症组(重症急性胰腺炎患者,24例)。选择52例体检健康者为健康组。采用全自动生化分析仪检测受试者肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)]、肾功能指标[肌酐(Scr)、血尿素氮(BUN)]以及淀粉酶(AMY)水平。采用酶联免疫吸附法检测血清中CXCL10、CCL22水平。采用急性胰腺炎严重程度床边指数(BISAP)评分评估急性胰腺炎患者疾病严重程度。采用Logistic回归分析中度重症和重症急性胰腺炎发生的影响因素。采用Pearson法分析急性胰腺炎患者血清CXCL10、CCL22水平及BISAP评分间的相关性。采用受试者工作特征(ROC)曲线评价血清CXCL10、CCL22水平诊断中度重症和重症急性胰腺炎的价值。结果:与健康组比较,轻症组ALT、Scr、BUN、AMY水平升高,中度重症组和重症组ALT、AST、Scr、BUN、AMY水平升高(均P<0.05)。与轻症组比较,中度重症组BUN水平升高,重症组ALT、AST、Scr、BUN水平升高(均P<0.05)。与中度重症组比较,重症组BUN水平升高(P<0.05)。四组血清CXCL10、CCL22水平及BISAP评分依次升高(均P<0.05)。急性胰腺炎患者血清CXCL10和CCL22水平呈正相关(P<0.05);血清CXCL10、CCL22水平与BISAP评分呈正相关(均P<0.05)。血清CXCL10、CCL22、BISAP评分是中度重症和重症急性胰腺炎发生的独立危险因素(均P<0.05)。血清CXCL10、CCL22对中度重症和重症急性胰腺炎均有一定诊断价值,且两项联合诊断价值更高(均P<0.05)。结论:急性胰腺炎患者血清CXCL10、CCL22水平呈高表达,且随疾病严重程度的加重而升高,两者联合诊断中度重症和重症急性胰腺炎的价值较高。

BISAP评分、白细胞介素-6、降钙素原与重症急性胰腺炎预后的相关性研究

目的 分析急性胰腺炎严重程度床边指数(BISAP)评分、白细胞介素-6(IL-6)、降钙素原(PCT)与重症急性胰腺炎(SAP)预后的相关性。方法 选取2020年1月-2023年9月我院收治的86例SAP患者,根据预后情况分为死亡组(27例)、生存组(59例)。所有患者入院后均予以胃肠减压、禁食、抗感染等对症治疗及预防并发症治疗,并检测患者入院时的BISAP评分、血清IL-6、PCT水平。比较生存组、死亡组的BISAP评分、IL-6及PCT水平,分析SAP患者预后不良的危险因素,采用Pearson直线相关分析IL-6、PCT水平及BISAP评分与SAP预后的相关性。结果 死亡组的BISAP评分、血清IL-6、PCT水平高于生存组(P<0.05)。经Logistic回归分析显示,BISAP评分及血清IL-6、PCT水平较高是SAP患者预后不良的危险因素(OR>1,P<0.05)。Pearson直线相关分析显示,BISAP评分及血清IL-6、PCT水平与SAP患者预后不良呈正相关(r>0,P<0.05)。结论 SAP患者的BISAP评分及血清IL-6、PCT水平较高与预后不良密切相关。

全身炎症反应指数对急性胰腺炎患者严重程度的评估价值研究

背景急性胰腺炎(AP)是常见的消化系统急症之一,中度重症及重症AP疾病进展迅速,早期准确识别对其防治及预后评估具有重要意义,但目前仍缺乏有效、简便的预测指标。目的 探讨AP患者全身炎症反应指数(SIRI)的早期动态变化及其对AP严重程度的预测价值。方法 选取2020年8月—2023年3月入住首都医科大学附属北京天坛医院消化内科且符合纳入及排除标准的AP患者221例为研究对象。根据2012年修订版亚特兰大分类标准,将患者分为轻症组(MAP组,轻症AP)和非轻症组(non-MAP组,包括中度重症及重症AP)。通过查阅病例收集患者入院时、入院后48 h内的SIRI值(SIRI 0 h、SIRI 48 h)和C反应蛋白(CRP)(CRP 0 h、CRP 48 h)。应用受试者工作特征(ROC)曲线,计算ROC曲线下面积分析SIRI预测non-MAP的价值并与临床常用炎症指标CRP进行比较。结果 最终共纳入221例AP患者,其中MAP组102例,non-MAP组119例。non-MAP组患者SIRI0 h、SIRI 48 h均高于MAP组(P<0.001)。ROC曲线显示,SIRI 0 h、SIRI 48 h预测non-MAP的AUC分别为0.685(95%CI=0.615~0.756)、0.753(95%CI=0.689~0.816),与同时间段的CRP[0.607(95%CI=0.533~0.681),0.752(95%CI=0.687~0.817)]比较,差异无统计学意义(Z=1.67、P=0.095;Z=0.02、P=0.981)。SIRI 48 h预测non-MAP的最佳临界值为2.49,灵敏度、特异度、阳性预测值和阴性预测值分别为81.51%、58.82%、69.78%和73.17%。结论SIRI是一种价格低廉、易于获得的检测方法,可作为早期AP严重程度的评估指标。

改良CT严重指数评分联合血清学指标评估急性胰腺炎患者预后的价值

目的探讨改良CT严重指数评分(MCTSI)联合血清学指标评估急性胰腺炎(AP)患者预后的价值。方法选择2018年1月至2022年1月南通市第一人民医院收治的248例AP患者为研究对象,根据病情将患者分为轻症组(n=152)与中重症组(n=96)。所有患者均接受胰腺增强CT检查、血常规及血钙、血清淀粉酶、血清脂肪酶、降钙素原(PCT)、白细胞介素-6(IL-6)、IL-17、C-反应蛋白(CRP)水平检测,统计28 d内死亡率,比较病情不同严重程度、不同预后AP患者MCTSI评分及实验室指标水平差异。结果多因素Logistic分析显示,MCTSI及血清淀粉酶、血清脂肪酶、PCT水平是影响AP患者严重程度的独立性危险因素(P<0.05)。发病后28 d内,248例患者中196例存活、52例死亡,总体生存率为79.03%。轻症组、中重症组的生存率分别为91.4%(139/152)、59.4%(57/96),中重症组患者的生存率显著较低(χ2=12.94,P<0.001)。ROC曲线分析显示,MCTSI、PCT、血钙单独预测患者28 d内死亡的AUC分别为0.870、0.785、0.679,敏感性分别为72.6%、68.4%、69.3%,特异性分别为75.9%、69.7%、64.4%。当三者联合检测时,可将AUC提高至0.913。多因素Cox生存分析显示,MCTSI及血清淀粉酶、血清脂肪酶、PCT水平是影响AP患者预后的独立性危险因素。结论MCTSI评分联合血清学指标检测,可提高AP病情严重程度及预后的预测效能。

MCTSI、CTSI、MPV、HMGB-1、AChE活性与急性胰腺炎患者病情及预后的关系

目的 探讨改良CT严重指数(MCTSI)、CT严重指数(CTSI)、平均血小板体积(MPV)、高迁移率族蛋白-1(HMGB-1)、乙酰胆碱酯酶(AChE)活性与急性胰腺炎(AP)患者病情及预后的关系。方法 选取220例AP患者,根据病情将其分为轻症急性胰腺炎(MAP)组(n=63)、中重症急性胰腺炎(MSAP)组(n=85)和重症急性胰腺炎(SAP)组(n=72)。所有患者行MCTSI、CTSI评分,同时检测血清MPV、HMGB-1、AChE水平,采用Pearson法验证各指标的相关性。随访3个月,依据预后分组,比较不同预后AP患者MCTSI、CTSI评分及MPV、HMGB-1、AChE差异,采用受试者工作特征(ROC)曲线分析上述指标对AP预后的预测价值。结果 三组MCTSI、CTSI评分、MPV、HMGB-1、AChE比较,差异均有统计学意义(F分别=34.90、154.62、230.50、92.35、101.20,P均<0.05),SAP组MCTSI、CTSI评分、MPV、HMGB-1明显高于MSAP组和MAP组(LSD-t分别=8.32、11.43、15.16、24.66、17.50、30.24、14.32、18.28,P均<0.05),AChE明显低于MSAP组和MAP组(LSD-t分别=13.08、19.79,P均<0.05)。AP患者MCTSI、CTSI评分分别与MPV、HMGB-1呈正相关(r分别=0.21、0.21、0.18、0.25,P均<0.05),与AChE呈负相关(r分别=-0.33、-0.34,P均<0.05)。预后不良组MCTSI、CTSI评分、MPV、HMGB-1高于预后良好组,AChE低于预后良好组,差异均有统计学意义(t分别=10.66、5.63、24.15、7.02、-14.54,P均<0.05)。ROC曲线显示,MCTSI、CTSI、MPV、HMGB-1、AChE联合预测AP患者不良预后的ROC曲线下面积(AUC)为0.91(95%CI 0.86~0.94),高于各指标单独预测(Z分别=2.78、3.39、2.78、2.44、2.89,P均<0.05)。结论 AP患者随着病情加重,MCTSI、CTSI评分及MPV、HMGB-1显著升高,AChE活性降低,联合检测MCTSI、CTSI、MPV、HMGB-1、AChE对AP患者病情及预后评估均有较高的应用价值。

TyG指数、GLR联合BISAP评分对高甘油三酯血症性急性胰腺炎严重程度的早期预测价值分析

目的分析甘油三酯-葡萄糖(TyG)指数、葡萄糖与淋巴细胞比值(GLR)联合急性胰腺炎严重程度床边指数(BISAP)评分对高甘油三酯血症性急性胰腺炎(HTG-AP)严重程度的早期预测价值。方法回顾性分析2018年5月至2023年5月武汉市第三医院收治的166例HTG-AP患者的临床资料,其中非重症组113例,重症组53例。比较两组入院24 h内采集的临床资料,采用多因素logistic回归分析重症HTG-AP发生的独立影响因素,采用受试者工作特征(ROC)曲线分析TyG指数、GLR、BISAP评分预测重症HTG-AP的效能。结果重症组高血压病、糖尿病人数比例大于非重症组,住院时间长于非重症组,淋巴细胞(LYM)、钙(Ca^(2+))水平低于非重症组,红细胞体积分布宽度(RDW)、D-二聚体(DDI)、C反应蛋白(CRP)、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、TyG指数、GLR水平及BISAP评分高于非重症组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,较高水平的TyG指数、GLR、BISAP评分均是促进重症HTG-AP发生的独立危险因素(P<0.05)。ROC曲线分析结果显示,TyG指数、GLR、BISAP评分均具有预测重症HTG-AP发生的应用价值(P<0.05),且BISAP评分联合TyG指数或GLR的预测效能较单一指标更优。结论TyG指数、GLR及BISAP评分与HTG-AP严重程度相关,TyG指数或GLR联合BISAP评分对HTG-AP严重程度有较高的早期预测价值。

重症急性胰腺炎患者并发急性肾损伤的影响因素分析

目的探讨重症急性胰腺炎(SAP)患者并发急性肾损伤(AKI)的影响因素。方法采用回顾性研究的方法,收集66例SAP患者的临床资料,根据是否并发AKI分为AKI组和非AKI组,分别采用Logistic回归和受试者操作特征(ROC)曲线分析SAP患者并发AKI的危险因素。结果SAP合并AKI患者的总体年龄和急性生理学和慢性健康状况评价(APACHEⅡ)评分高于未合并者,但糖尿病多见于未合并者(P<0.05)。与非AKI组相比,AKI组患者入院时的CRP、全身炎症反应指数(SIRI)、血清肌酐、CRP/白蛋白比值、D-二聚体升高,但三酰甘油-葡萄糖(TyG)指数、白蛋白、总胆固醇、HDL-C、血钙水平下降(P<0.05)。逐步回归分析结果显示,APACHEⅡ评分升高、SIRI升高、血小板/淋巴细胞比值(PLR)升高、全身免疫炎症指数(SII)降低、血钙水平下降是SAP患者并发AKI的独立危险因素(P<0.05)。ROC曲线结果显示,除血清肌酐外,APACHEⅡ评分、SIRI指数、血钙水平对SAP患者并发AKI有一定的诊断价值,其中APACHEⅡ评分的AUC为0.880(95%CI 0.787~0.974,截断值11.50分),SIRI指数的AUC为0.662(95%CI 0.521~0.804,截断值10.89),血钙水平的AUC为0.754(95%CI 0.627~0.881,截断值2.07 mmol/L),P均<0.05;当上述三种指标联合血清肌酐时可进一步提高对于SAP患者并发AKI的诊断效能,其中血清肌酐+血钙的AUC最大,达0.969(95%CI 0.929~1.000,P<0.05)。结论APACHEⅡ评分、SIRI指数、PLR指数、SII指数、血钙水平是SAP并发AKI的影响因素,APACHEⅡ评分、SIRI指数和血钙水平对SAP患者并发AKI具有诊断价值,三者联合血清肌酐可提高对AKI的诊断效能,为临床识别SAP患者并发AKI提供新的手段。

GPS评分和PNI指数对急性胰腺炎严重程度和预后的预测价值研究

目的探讨格拉斯哥预后评分(GPS)和预后营养指数(PNI)对早期预测急性胰腺炎严重程度和预后的临床应用价值。方法回顾性收集聊城市第二人民医院2019年1月1日—2023年3月31日连续收治的280例急性胰腺炎患者的临床资料,包括患者一般临床资料、实验室各项相关指标(入院24 h内)、临床诊疗及预后指标等。将患者分为重症急性胰腺炎(SAP)组(90例)与非SAP组(190例),比较两组各项指标的差异,并绘制受试者工作特征(ROC)曲线寻找PNI最佳诊断值;然后将SAP患者根据GPS和PNI分组比较其临床转归及预后。结果两组患者基线资料无明显统计学差异(P>0.05);与非SAP患者相比,SAP患者GPS评分2分明显更多(46.67%vs.11.05%,P<0.001),PNI指数明显更低(42.02 vs.46.30,P<0.001)。ROC曲线分析显示PNI指数最佳截断值为43.73。与A组相比,B组患者的ICU治疗率更高、时间更长(46.2%vs.25.5%,中位0 d vs.0 d,P=0.041,0.010),禁食时间更长(中位13 d vs.10 d,P=0.004),引流管数量更多(中位3根vs.2根,P=0.003),总住院时间更长(中位25 d vs.20 d,P=0.005),住院费用更高(中位154055.14元vs.126152.12元,P=0.004)、死亡率更高(33.3%vs.13.7%,P=0.027)。结论GPS评分和PNI指数对急性胰腺炎患者早期严重程度和SAP患者预后具有预测价值。

基于 BISAP 评分系统的护理干预对重症胰腺炎 患者自我护理能力、生活质量的影响分析

目的探讨基于床旁严重度指数(Bedside Index of Severity in Acute Pancreatitis,BISAP)评分系统的护理干预对重症胰腺炎患者自我护理能力、生活质量的影响。方法方便选取2022年1月-2023年5月福建医科大学附属协和医院收治的88例重症胰腺炎患者为研究对象,接随机数表法分为对照组和BISAP评分组,各44例。对照组接受临床重症胰腺炎患者的常规护理,BISAP评分组接受基于BISAP评分系统的护理干预。对比两组患者的护理1周、护理2周后自我护理能力、生活质量及护理满意度。结果护理1周、护理2周时,BISAP评分组的自我护理能力评估量表中对健康知识掌握、自我认同、自我责任感、自我护理能力等维度评分值均高于对照组,差异有统计学意义(P均<0.05);BISAP评分组的生活质量综合评估量表中躯体功能、心理功能、社会功能、物质生活状态等维度评分值均高于对照组,差异有统计学意义(P均<0.05)。出院当日,BISAP评分组的平均护理满意度评分(94.76±5.43)分高于对照组(84.93±8.05)分,差异有统计学意义(t=6.715,P<0.05)。结论基于BISAP评分系统的护理干预应用于重症胰腺炎患者中,可积极提升其自我护理能力及生活质量,同时有助于护理满意度的优化。

甘油三酯葡萄糖指数与急性胰腺炎严重程度的相关性分析

目的:探讨甘油三酯葡萄糖(triglyceride glucose,TyG)指数与急性胰腺炎(acute pancreatitis,AP)严重程度的相关性。方法:选取2021年1月至2023年8月于湖北医药学院附属随州医院住院的534例AP患者,根据严重程度分为重症急性胰腺炎(SAP)组99例和非重症急性胰腺炎(NSAP)组435例,比较两组间一般临床资料、实验室指标的差异。用二元Logistic回归探讨AP严重程度的独立危险因素,并绘制相应的受试者工作特征(ROC)曲线,评估其预测SAP的准确性和可靠性。探讨TyG指数在不同病因里对SAP的预测价值。结果:SAP的独立危险因素为年龄、凝血酶原时间(PT)、TyG指数,男性是SAP的独立保护因素。年龄、PT、TyG指数及三者联合指标对SAP的诊断都具有一定价值,其曲线下面积依次为0.601[95%CI(0.537,0.665),P=0.002]、0.62[95%CI(0.559,0681),P<0.001]、0.747[95%CI(0.699,0.795),P<0.001]、0.829[95%CI(0.782,0.876),P<0.001]。TyG指数在胆源性、高脂血症性及其他病因性急性胰腺炎组中预测SAP的AUC分别为0.890[95%CI(0.821,0.959),P<0001]、0.766[95%CI(0.626,0.906),P<0.001]、0.802[95%CI(0.737,0.867),P<0.001]。结论:TyG指数与AP严重程度呈正相关,年龄、PT、TyG指数联合可以提高预测AP严重程度的准确性。TyG指数在胆源性、高脂血症性及其他病因性急性胰腺炎组中对SAP均有预测价值,但存在差异。