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） syst...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.展开更多
AIM: To assess the value of plasma melatonin in predicting acute pancreatitis when combined with the acute physiology and chronic health evaluation?II?(APACHEII) and bedside index for severity in acute pancreatitis (B...AIM: To assess the value of plasma melatonin in predicting acute pancreatitis when combined with the acute physiology and chronic health evaluation?II?(APACHEII) 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 concentration group (34 cases) or a low concentration group (21 cases). Differences in the incidence of high scores, according to the APACHEII and BISAP scoring systems, 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.展开更多
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 bas...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.展开更多
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 investigate...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.展开更多
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,recognizin...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.展开更多
Objective:Our aim was to prospectively evaluate the accuracy of the bedside index for severity in acute pancreatitis(BISAP)score in predicting mortality,as well as intermediate markers of severity,in a tertiary care c...Objective:Our aim was to prospectively evaluate the accuracy of the bedside index for severity in acute pancreatitis(BISAP)score in predicting mortality,as well as intermediate markers of severity,in a tertiary care centre in east central India,which caters mostly for an economically underprivileged population.Methods:A total of 119 consecutive cases with acute pancreatitis were admitted to our institution between November 2012 and October 2014.BISAP scores were calculated for all cases,within 24 hours of presentation.Ranson’s score and computed tomography severity index(CTSI)were also established.The respective abilities of the three scoring systems to predict mortality was evaluated using trend and discrimination analysis.The optimal cut-off score for mortality from the receiver operating characteristics(ROC)curve was used to evaluate the development of persistent organ failure and pancreatic necrosis(PNec).Results:Of the 119 cases,42(35.2%)developed organ failure and were classified as severe acute pancreatitis(SAP),47(39.5%)developed PNec,and 12(10.1%)died.The area under the curve(AUC)results for BISAP score in predicting SAP,PNec,and mortality were 0.962,0.934 and 0.846,respectively.Ranson’s score showed a slightly lower accuracy for predicting SAP(AUC 0.956)and mortality(AUC 0.841).CTSI was the most accurate in predicting PNec,with an AUC of 0.958.The sensitivity and specificity of BISAP score,with a cut-off of≥3 in predicting mortality,were 100%and 69.2%,respectively.Conclusions:The BISAP score represents a simple way of identifying,within 24 hours of presentation,patients at greater risk of dying and the development of intermediate markers of severity.This risk stratification method can be utilized to improve clinical care and facilitate enrolment in clinical trials.展开更多
BACKGROUND Acute pancreatitis(AP)is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment.An accurate assessment and precise staging of severity are essential in initial...BACKGROUND Acute pancreatitis(AP)is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment.An accurate assessment and precise staging of severity are essential in initial intensive therapy.AIM To explore the prognostic value of inflammatory markers and several scoring systems[Acute Physiology and Chronic Health Evaluation II,the bedside index of severity in AP(BISAP),Ranson’s score,the computed tomography severity index(CTSI)and sequential organ failure assessment]in severity stratification of earlyphase AP.METHODS A total of 463 patients with AP admitted to our hospital between 1 January 2021 and 30 June 2024 were retrospectively enrolled in this study.Inflammation marker and scoring system levels were calculated and compared between different severity groups.Relationships between severity and several predictors were evaluated using univariate and multivariate logistic regression models.Predictive ability was estimated using receiver operating characteristic curves.RESULTS Of the 463 patients,50(10.80%)were classified as having severe AP(SAP).The results revealed that the white cell count significantly increased,whereas the prognostic nutritional index measured within 48 hours(PNI48)and calcium(Ca^(2+))were decreased as the severity of AP increased(P<0.001).According to multivariate logistic regression,C-reactive protein measured within 48 hours(CRP_(48)),Ca^(2+)levels,and PNI48 were independent risk factors for predicting SAP.The area under the curve(AUC)values for the CRP_(48),Ca^(2+),PNI48,Acute Physiology and Chronic Health Evaluation II,sequential organ failure assessment,BISAP,CTSI,and Ranson scores for the prediction of SAP were 0.802,0.736,0.871,0.799,0.783,0.895,0.931 and 0.914,respectively.The AUC for the combined CRP_(48)+Ca^(2+)+PNI48 model was 0.892.The combination of PNI48 and Ranson achieved an AUC of 0.936.CONCLUSION Independent risk factors for developing SAP include CRP_(48),Ca^(2+),and PNI48.CTSI,BISAP,and the combination of PNI48 and the Ranson score can act as reliable predictors of SAP.展开更多
Objective:Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation(APACHE)II,Bedside Index of Severity in Acute Pancreatitis(BISAP),Ranson’s score and modified Computed Tomo...Objective:Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation(APACHE)II,Bedside Index of Severity in Acute Pancreatitis(BISAP),Ranson’s score and modified Computed Tomography Severity Index(CTSI)in predicting the severity of acute pancreatitis based on Atlanta 2012 definitions in a tertiary care hospital in northern India.Methods:Fifty patients with acute pancreatitis admitted to our hospital during the period of March 2015 to September 2016 were included in the study.APACHE II,BISAP and Ranson’s score were calculated for all the cases.Modified CTSI was also determined based on a pancreatic protocol contrast enhanced computerized tomography(CT).Optimal cut-offs for these scoring systems and the area under the curve(AUC)were evaluated based on the receiver operating characteristics(ROC)curve and these scoring systems were compared prospectively.Results:Of the 50 cases,14 were graded as severe acute pancreatitis.Pancreatic necrosis was present in 15 patients,while 14 developed persistent organ failure and 14 needed intensive care unit(ICU)admission.The AUC for modified CTSI was consistently the highest for predicting severe acute pancreatitis(0.919),pancreatic necrosis(0.993),organ failure(0.893)and ICU admission(0.993).APACHE II was the second most accurate in predicting severe acute pancreatitis(AUC 0.834)and organ failure(0.831).APACHE II had a high sensitivity for predicting pancreatic necrosis(93.33%),organ failure(92.86%)and ICU admission(92.31%),and also had a high negative predictive value for predicting pancreatic necrosis(96.15%),organ failure(96.15%)and ICU admission(95.83%).Conclusion:APACHE II is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for tertiary care during the course of their illness and therefore need early resuscitation and prompt referral,especially in resource-limited developing countries.展开更多
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...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。展开更多
目的比较BISAP评分与Ranson’s评分在预测急性胰腺炎(acute pancreatitis,AP)的严重度及病死率方面的运用价值。方法以2007年6月到2010年10月入住本院的AP患者为研究对象,资料完整诊断明确者共有652例,采用BISAP(the bedside index for ...目的比较BISAP评分与Ranson’s评分在预测急性胰腺炎(acute pancreatitis,AP)的严重度及病死率方面的运用价值。方法以2007年6月到2010年10月入住本院的AP患者为研究对象,资料完整诊断明确者共有652例,采用BISAP(the bedside index for severity in AP)评分与Ranson’s评分比较,受试者工作特性曲线(receiver-operating curve,ROC)行回顾性分析,在预计AP的严重度及病死率方面的差异。结果在652例患者中,通过发病48 h内出现器官衰竭确定为重症者108例(16.6%),共死亡21例(3.2%),BISAP评分≥3分的44例(6.7%),入院48 h内Ranson’s评分≥3分者213例(32.7%)。BISAP与Ranson’s评分二者在评价预后方面的差异有统计学意义,其中严重度的曲线下面积BISAP、Ranson’s评分系统分别为:0.846(95%CI 0.808～0.883),0.771(95%CI 0.722～0.820);死亡率分别是:0.809(95%CI 0.699～0.920),0.762(95%CI 0.638～0.885)。结论 BISAP评分系统在急性胰腺炎早期,针对患者严重度、死亡率的预后评估的准确性明显高于Ranson’s评分,是目前最简易、及时、连续性强并且对患者而言经济花费少的评分系统,可在临床广泛推广。展开更多
目的:比较联合胰腺外炎症CT评分(extropancreatic inflammation on abdominal computed tomography,EPIC)及中性粒细胞与淋巴细胞比值(neutropil-lymphocyte rate,NLR)与急性胰腺炎床旁严重指数(bedside index for severity in acute pa...目的:比较联合胰腺外炎症CT评分(extropancreatic inflammation on abdominal computed tomography,EPIC)及中性粒细胞与淋巴细胞比值(neutropil-lymphocyte rate,NLR)与急性胰腺炎床旁严重指数(bedside index for severity in acute pancreatitis,BISAP)早期预测急性胰腺炎(acute pancreatitis,AP)严重性的价值.方法:对2010-01/2014-04住院的358例AP患者资料进行分析.对所有患者进行EPIC、NLR、BISAP、改良Marshall及联合指标评分.联合指标评分为EPIC分数加上NLR得分(其中NLR≥7.345为1分,<7.345为0分).轻度AP划入轻症组,中度AP重度AP划入重症组.两组的EPIC、NLR、BISAP及联合指标评分进行t检验,采用Spearman检验评价各类指标评分与重症的相关性.对各类指标早期预测AP严重性的曲线下面积(area under curve,AUC)及敏感性、特殊性、准确性、阳性预测值、阴性预测值、约登指数进行了研究.结果:358例AP中,重症55例(占15.363%,55/358),轻症303例(占84.637%,303/358).重症组的EPIC、NLR、BISAP及联合指标评分比轻症组的评分高,分别为4.200±1.393 vs 1.373±1.333,14.358±5.908 vs 7.929±4.514,2.655±0.985 vs 0.993±0.843,5.164±1.385 vs 1.819±1.493,所有P=0.000.EPIC、NLR、BISAP及联合指标评分与重症的相关系数分别为0.529、0.406、0.546及0.554,所有P=0.000.EPIC、NLR、BISAP及联合指标评分早期预测AP严重性的AUC分别为0.914(95%CI:0.867-0.961),0.825(95%CI:0.778-0.872),0.911(95%CI:0.863-0.960)及0.938(95%CI:0.900-0.975),所有P=0.000.BISAP及联合指标评分预测重症的敏感性、特异性、准确性、阳性预测值、阴性预测值及约登指数分别为90.909%、80.528%、82.123%、45.872%、97.992%、0.714及85.455%、86.469%、86.313%、53.409%、97.037%、0.719.结论:联合EPIC及NLR指标简便易于获得,其早期预测AP严重性的曲线下面积较BISAP的预测面积大,与其他指标相比,其预测的重症AP的特异性及准确性较高.展开更多
文摘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.
基金Supported by The Wenzhou Municipal Science and Technology Commission Major Projects Funds,No.20090006
文摘AIM: To assess the value of plasma melatonin in predicting acute pancreatitis when combined with the acute physiology and chronic health evaluation?II?(APACHEII) 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 concentration group (34 cases) or a low concentration group (21 cases). Differences in the incidence of high scores, according to the APACHEII and BISAP scoring systems, 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.
文摘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.
文摘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.
基金the Science and Technology Program of Guiyang Baiyun District Science and Technology Bureau.No.[2017]50Science and Technology Program of Guiyang Municipal Bureau of Science and Technology,No.[2018]1-72Science and Technology Fund Project of Guizhou Provincial Health Commission,No.gzwkj2021-127.
文摘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.
文摘Objective:Our aim was to prospectively evaluate the accuracy of the bedside index for severity in acute pancreatitis(BISAP)score in predicting mortality,as well as intermediate markers of severity,in a tertiary care centre in east central India,which caters mostly for an economically underprivileged population.Methods:A total of 119 consecutive cases with acute pancreatitis were admitted to our institution between November 2012 and October 2014.BISAP scores were calculated for all cases,within 24 hours of presentation.Ranson’s score and computed tomography severity index(CTSI)were also established.The respective abilities of the three scoring systems to predict mortality was evaluated using trend and discrimination analysis.The optimal cut-off score for mortality from the receiver operating characteristics(ROC)curve was used to evaluate the development of persistent organ failure and pancreatic necrosis(PNec).Results:Of the 119 cases,42(35.2%)developed organ failure and were classified as severe acute pancreatitis(SAP),47(39.5%)developed PNec,and 12(10.1%)died.The area under the curve(AUC)results for BISAP score in predicting SAP,PNec,and mortality were 0.962,0.934 and 0.846,respectively.Ranson’s score showed a slightly lower accuracy for predicting SAP(AUC 0.956)and mortality(AUC 0.841).CTSI was the most accurate in predicting PNec,with an AUC of 0.958.The sensitivity and specificity of BISAP score,with a cut-off of≥3 in predicting mortality,were 100%and 69.2%,respectively.Conclusions:The BISAP score represents a simple way of identifying,within 24 hours of presentation,patients at greater risk of dying and the development of intermediate markers of severity.This risk stratification method can be utilized to improve clinical care and facilitate enrolment in clinical trials.
文摘BACKGROUND Acute pancreatitis(AP)is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment.An accurate assessment and precise staging of severity are essential in initial intensive therapy.AIM To explore the prognostic value of inflammatory markers and several scoring systems[Acute Physiology and Chronic Health Evaluation II,the bedside index of severity in AP(BISAP),Ranson’s score,the computed tomography severity index(CTSI)and sequential organ failure assessment]in severity stratification of earlyphase AP.METHODS A total of 463 patients with AP admitted to our hospital between 1 January 2021 and 30 June 2024 were retrospectively enrolled in this study.Inflammation marker and scoring system levels were calculated and compared between different severity groups.Relationships between severity and several predictors were evaluated using univariate and multivariate logistic regression models.Predictive ability was estimated using receiver operating characteristic curves.RESULTS Of the 463 patients,50(10.80%)were classified as having severe AP(SAP).The results revealed that the white cell count significantly increased,whereas the prognostic nutritional index measured within 48 hours(PNI48)and calcium(Ca^(2+))were decreased as the severity of AP increased(P<0.001).According to multivariate logistic regression,C-reactive protein measured within 48 hours(CRP_(48)),Ca^(2+)levels,and PNI48 were independent risk factors for predicting SAP.The area under the curve(AUC)values for the CRP_(48),Ca^(2+),PNI48,Acute Physiology and Chronic Health Evaluation II,sequential organ failure assessment,BISAP,CTSI,and Ranson scores for the prediction of SAP were 0.802,0.736,0.871,0.799,0.783,0.895,0.931 and 0.914,respectively.The AUC for the combined CRP_(48)+Ca^(2+)+PNI48 model was 0.892.The combination of PNI48 and Ranson achieved an AUC of 0.936.CONCLUSION Independent risk factors for developing SAP include CRP_(48),Ca^(2+),and PNI48.CTSI,BISAP,and the combination of PNI48 and the Ranson score can act as reliable predictors of SAP.
文摘Objective:Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation(APACHE)II,Bedside Index of Severity in Acute Pancreatitis(BISAP),Ranson’s score and modified Computed Tomography Severity Index(CTSI)in predicting the severity of acute pancreatitis based on Atlanta 2012 definitions in a tertiary care hospital in northern India.Methods:Fifty patients with acute pancreatitis admitted to our hospital during the period of March 2015 to September 2016 were included in the study.APACHE II,BISAP and Ranson’s score were calculated for all the cases.Modified CTSI was also determined based on a pancreatic protocol contrast enhanced computerized tomography(CT).Optimal cut-offs for these scoring systems and the area under the curve(AUC)were evaluated based on the receiver operating characteristics(ROC)curve and these scoring systems were compared prospectively.Results:Of the 50 cases,14 were graded as severe acute pancreatitis.Pancreatic necrosis was present in 15 patients,while 14 developed persistent organ failure and 14 needed intensive care unit(ICU)admission.The AUC for modified CTSI was consistently the highest for predicting severe acute pancreatitis(0.919),pancreatic necrosis(0.993),organ failure(0.893)and ICU admission(0.993).APACHE II was the second most accurate in predicting severe acute pancreatitis(AUC 0.834)and organ failure(0.831).APACHE II had a high sensitivity for predicting pancreatic necrosis(93.33%),organ failure(92.86%)and ICU admission(92.31%),and also had a high negative predictive value for predicting pancreatic necrosis(96.15%),organ failure(96.15%)and ICU admission(95.83%).Conclusion:APACHE II is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for tertiary care during the course of their illness and therefore need early resuscitation and prompt referral,especially in resource-limited developing countries.
文摘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。
文摘目的:比较联合胰腺外炎症CT评分(extropancreatic inflammation on abdominal computed tomography,EPIC)及中性粒细胞与淋巴细胞比值(neutropil-lymphocyte rate,NLR)与急性胰腺炎床旁严重指数(bedside index for severity in acute pancreatitis,BISAP)早期预测急性胰腺炎(acute pancreatitis,AP)严重性的价值.方法:对2010-01/2014-04住院的358例AP患者资料进行分析.对所有患者进行EPIC、NLR、BISAP、改良Marshall及联合指标评分.联合指标评分为EPIC分数加上NLR得分(其中NLR≥7.345为1分,<7.345为0分).轻度AP划入轻症组,中度AP重度AP划入重症组.两组的EPIC、NLR、BISAP及联合指标评分进行t检验,采用Spearman检验评价各类指标评分与重症的相关性.对各类指标早期预测AP严重性的曲线下面积(area under curve,AUC)及敏感性、特殊性、准确性、阳性预测值、阴性预测值、约登指数进行了研究.结果:358例AP中,重症55例(占15.363%,55/358),轻症303例(占84.637%,303/358).重症组的EPIC、NLR、BISAP及联合指标评分比轻症组的评分高,分别为4.200±1.393 vs 1.373±1.333,14.358±5.908 vs 7.929±4.514,2.655±0.985 vs 0.993±0.843,5.164±1.385 vs 1.819±1.493,所有P=0.000.EPIC、NLR、BISAP及联合指标评分与重症的相关系数分别为0.529、0.406、0.546及0.554,所有P=0.000.EPIC、NLR、BISAP及联合指标评分早期预测AP严重性的AUC分别为0.914(95%CI:0.867-0.961),0.825(95%CI:0.778-0.872),0.911(95%CI:0.863-0.960)及0.938(95%CI:0.900-0.975),所有P=0.000.BISAP及联合指标评分预测重症的敏感性、特异性、准确性、阳性预测值、阴性预测值及约登指数分别为90.909%、80.528%、82.123%、45.872%、97.992%、0.714及85.455%、86.469%、86.313%、53.409%、97.037%、0.719.结论:联合EPIC及NLR指标简便易于获得,其早期预测AP严重性的曲线下面积较BISAP的预测面积大,与其他指标相比,其预测的重症AP的特异性及准确性较高.
