四种评分系统对急性胰腺炎严重程度的预测价值

目的:探讨APACHE-O(APACHE-Ⅱ+肥胖指标评分)、APACHE-Ⅱ、Ranson、Balthazar CT评分系统(CTSI)对急性重症胰腺炎(SAP)的预测价值。方法:回顾性研究我院2005年1月1日至2011年1月1日急性胰腺炎(AP)患者321例,分别计算入院后各评分在不同诊断阈值对SAP预测的敏感性、特异性和准确性,绘制受试者工作曲线(ROC)。通过比较ROC的曲线下面积(AUC)来比较各评分系统对SAP的预测准确性。结果:取诊断阈值为7时,APACHE-O评分对SAP预测的敏感性、特异性和准确性分别为95.4%、76.6%和79.4%,约登指数和AUC分别为0.720和0.7355。取诊断阈值为8时,APACHE-Ⅱ评分对SAP预测的敏感性、特异性和准确性分别为90.4%、81.0%和82.6%,约登指数和AUC分别为0.714和0.6991。取诊断阈值为3时,Ranson评分对SAP预测的敏感性、特异性和准确性分别为75.0%、78.1%和77.6%,约登指数和AUC分别为0.531和0.7031。取诊断阈值为5时,CTSI评分对SAP预测的敏感性、特异性和准确性分别82.7%、91.4%和90%,约登指数和AUC分别为0.741和0.7769。结论:四种评分系统中,CTSI和APACHE-O对SAP有较高的早期预测准确性,优于APACHE-Ⅱ和Ranson评分系统。其中CTSI评分对SAP预测准确性优于APACHE-O评分系统,总体预测能力最高。CTSI评分可作为一项理想的SAP早期预测系统。

Predicitive value of APACHE-O,APACHE-II,Ranson and Balthazar CT scoring system on the severity of acute pancreatitis

Objective: To investigate the predictive value of APACHE-O,APACHE-Ⅱ,Ranson,Balthazar CT scoring systems in predicting the severity of acute pancreatitis(SAP).Methods: Data were collected retrospectively from 321 consecutive patients admitted in our hospital from 2005-01-01 to 2011-01-01 with acute pancreatitis(AP).Calculate the sensitivity,specificity and accuracy of APACHE-O,APACHE-Ⅱ,Ranson,Balthazar CT scoring systems in different cut-off levels.Receiver-operating curves(ROC) for prediction of SAP in early period were calculated using APACHE-O,APACHE-Ⅱ,Ranson and Balthazar CT scores in different cut-off levels.The area under the curve(AUC) was determined for comparing predictive accuracy.Results: At cut-off of 7,APACHE-O had sensitivity 95.4%,specificity 76.6% and overall accuracy 79.4%.The Youden’s index of and AUC of APACHE-O score were 0.720 and 0.7355,respectively.At cut-off of 8,APACHE-Ⅱ had sensitivity 90.4%,specificity 81.0% and overall accuracy 842.6%.The Youden’s index of and AUC of APACHE-Ⅱ were 0.714 and 0.6991,respectively.At cut-off of 3,Ranson had sensitivity 75.0%,specificity 78.1% and overall accuracy 77.6%,respectively.The Youden’s index and AUC of Ranson were 0.531 and 0.7031,respectively.At cut-off of 5,CTSI had sensitivity 82.7%,specificity 91.4% and overall accuracy 90.0%,respectively.The Youden’s index and AUC of CTSI were 0.741 and 0.7769,respectively.Conclusion: Our study results suggest that the CTSI and APACHE-O scoring systems are more accurate than the other two scoring systems for predicting of SAP.And the predictive accuracy of CTSI is higher that APACHE-O scoring system.CTSI is an usefull system in predicting severe pancreatitis in early period.