Comparison of scoring systems in predicting the severity of acute pancreatitis

AIM:To investigate the prognostic usefulness of several existing scoring systems in predicting the severity of acute pancreatitis(AP).METHODS:We retrospectively analyzed the prospectively collected clinical database from consecutive patients with AP in our institution between January 2011 and December 2012.Ranson,Acute Physiology and Chronic Health Evaluation(APACHE)-Ⅱ,and bedside index for severity in acute pancreatitis(BISAP)scores,and computed tomography severity index(CTSI)of all patients were calculated.Serum C-reactive protein(CRP)levels were measured at admission(CRPi)and after 24h(CRP24).Severe AP was defined as persistent organ failure for more than 48 h.The predictive accuracy of each scoring system was measured by the area under the receiver-operating curve(AUC).RESULTS:Of 161 patients,21(13%)were classified as severe AP,and 3(1.9%)died.Statistically significant cutoff values for prediction of severe AP were Ranson≥3,BISAP≥2,APACHE-Ⅱ≥8,CTSI≥3,and CRP24≥21.4.AUCs for Ranson,BISAP,APACHE-Ⅱ,CTSI,and CRP24 in predicting severe AP were 0.69(95%CI:0.62-0.76),0.74(95%CI:0.66-0.80),0.78(95%CI:0.70-0.84),0.69(95%CI:0.61-0.76),and0.68(95%CI:0.57-0.78),respectively.APACHE-Ⅱdemonstrated the highest accuracy for prediction of severe AP,however,no statistically significant pairwise differences were observed between APACHE-Ⅱand the other scoring systems,including CRP24.CONCLUSION:Various scoring systems showed similar predictive accuracy for severity of AP.Unique models are needed in order to achieve further improvement of prognostic accuracy.     

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.     

急性胰腺炎床旁严重度指数和无害性胰腺炎评分对急性胰腺炎预后的评估价值

目的 评价急性胰腺炎床旁严重度指数(BISAP)与无害性胰腺炎评分(HAPS)评估急性胰腺炎(AP)预后的价值.方法 回顾性分析2003年1月至2010年12月中山大学附属第一医院收治的442例AP患者资料,计算BISAP和HAP评分,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),分析它们对AP严重度、局部并发症、器官功能不全、预后的评估价值,并与传统的Ranson评分进行比较.结果 442例AP患者中,73例(16.5％)为重症急性胰腺炎(SAP).BISAP评分预测SAP、局部并发症、器官功能不全、病死结局的AUC分别是0.90(95％ CI:0.86～ 0.93)、0.82(95％ CI:0.76～0.89)、0.93(95％ CI:0.89 ～0.96)、0.93(95％ CI:0.87 ～0.98).BISAP评分和Ranson评分上述4项指标的AUC差异无统计学意义.HAP评分预测轻症急性胰腺炎(MAP)的特异性为85％,阳性预测值95％,AUC为0.73(95％CI:0.67 ～ 0.79).将BISAP和HAP评分相结合,2种评分均异常的患者发生不良结局的风险逐渐升高.结论 BISAP评分对AP预后的评估价值与Ranson评分相当,但更为简便.HAP评分能简单且准确地预测MAP的预后,BISAP和HAP评分相结合有助于更好地判断AP患者的预后.     

急性胰腺炎严重程度临床应用评分进展

急性胰腺炎是消化系统常见疾病之一,包括急性轻型胰腺炎及急性重症胰腺炎。重症者病情凶险,死亡率高。早期发现疾病重症趋势能更好地指导临床治疗。本文就急性胰腺炎严重程度的临床应用评分进展进行综述。     

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.     

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 contrast-enhanced 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 > or =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 > or =5 significantly correlated with death, complication present, and prolonged length of stay. Patients with a CTSI > or =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 > or =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.     

BISAP评分对急性胰腺炎严重程度及预后评估的临床价值

目的 通过与传统的急性胰腺炎(AP)病情评分系统比较,了解急性胰腺炎严重程度床边指数(BISAP)评分对AP严重程度及预后评估的临床价值.方法 回顾性分析2005年1月至2010年12月间收治的497例AP患者资料,分别进行BISAP、APACHEⅡ、Ranson及Balthazar CT( CTSI)评分,评估病情严重程度.应用受试者工作曲线下面积(AUC)比较BISAP评分与其他各评分系统对AP严重程度及胰腺坏死、器官功能衰竭、患者病死发生的预测能力.结果 497例患者中重症急性胰腺炎(SAP) 101例,轻症急性胰腺炎(MAP) 396例,MAP组和SAP组患者的年龄、性别、病因分布差异无统计学意义.497例患者的BISAP评分、APACHEⅡ评分、Ranson评分的平均分值分别为(1.08±1.01)、(5.79±4.00)、(1.69±1.59)分,两两相关(r值分别为0.612、0.568、0.577,P值均＜0.001).此外,SAP患者的BISAP评分、APACHEⅡ评分、Ranson评分的分值均显著大于MAP患者(P值均＜0.01).BISAP评分预测SAP的AUC值为0.762( 95％ CI 0.722～0.799),阳性截止(cutoff)值为2分,敏感性、特异性、阳性预测值、阴性预测值分别为63.4％、83.1％、48.1％、89.4％;预测胰腺坏死的AUC值为0.711(95％CI0.612～0.797),cutoff值为2分,敏感性、特异性、阳性预测值、阴性预测值分别为84.6％、46.7％、35.5％、89.7％;预测器官衰竭的AUC值为0.777(95％ CI0.683 ～0.854),cutoff值为2分,敏感性、特异性、阳性预测值、阴性预测值分别为93.1％、51.4％、43.5％、94.9％;预测患者病死的AUC值为0.808(95％ CI 0.718 ～0.880),cutoff值为3分,敏感性、特异性、阳性预测值、阴性预测值分别为83.3％、67.4％、25.6％、96.8％.BISAP评分与其他评分系统预测SAP各预后指标的差异均无统计学意义.结论 BISAP评分对AP严重程度及预后的评估价值与其他传统的评分系统相同,但其只有5项指标,且均可在入院24h内采集,可以早期、简便地预测SAP,值得在临床推广应用.     

The Usefulness of the MEESSI Score for Risk Stratification of Patients With Acute Heart Failure at the Emergency Department

Introduction and objectives

The MEESSI scale stratifies acute heart failure (AHF) patients at the emergency department (ED) according to the 30-day mortality risk. We validated the MEESSI risk score in a new cohort of Spanish patients to assess its accuracy in stratifying patients by risk and to compare its performance in different settings.

A novel risk score for predicting 6-months mortality at the time of hospital discharge in patients admitted with acute coronary syndrome

BackgroundIn patients with ACS, risk assessment at hospital discharge has not received much consideration in prior risk scoring systems. Hence, there is a need for a reliable and simple tool to identify patients with high mortality risk at discharge form the hospital.MethodsIn a 1-year observational, prospective study, 1012 patients admitted with ACS were followed up for 6 months after discharge. From 26 potential variables, a new risk score to predict 6-month mortality was developed.ResultsA multi-variant Cox regression analysis with forward stepwise variable selection was performed and 10 highly significant independent predictors of 6-month mortality were identified. These include previous history of ACS, higher Killip class at admission, NYHA class at discharge, recurrent ischemia during hospital stay, heart failure, requiring ionotropic supports, requiring hemodialysis, presence of arrhythmia, left ventricular dysfunction detected on echocardiography and elevated admission blood glucose levels. Points were given to each variable and a total score was calculated. A risk score of 0–4 (low risk) predicted a mortality of 3.7%,a risk score of 5–15 (Intermediate risk) predicted a mortality of 16.4% and a risk score of 11–15 predicted a mortality of 32.0% over a 6-month period. The new risk score was noninferior to GRACE risk score in its predictive accuracy of 6-month mortality in the same cohort of patients (p < 0.05).ConclusionThe risk score developed in our study can be easily calculated at the bedside and is aimed at identifying high risk patients who require more intense follow up after discharge.     

A prospective study of the Bedside Index for Severity in Acute Pancreatitis (BISAP) score in acute pancreatitis: An Indian perspective

IntroductionA simple and easily applicable system for stratifying patients with acute pancreatitis is lacking. The aim of our study was to evaluate the ability of BISAP score to predict mortality in acute pancreatitis patients from our institution and to predict which patients are at risk for development of organ failure, persistent organ failure and pancreatic necrosis.MethodsAll patients with acute pancreatitis were included in the study. BISAP score was calculated within 24 h of admission. A Contrast CT was used to differentiate interstitial from necrotizing pancreatitis within seven days of hospitalization whereas Marshall Scoring System was used to characterize organ failure.ResultsAmong 246 patients M:F = 153:93, most common aetiology among men was alcoholism and among women was gallstone disease. 207 patients had no organ failure and remaining 39 developed organ failure. 17 patients had persistent organ failure, 16 of those with BISAP score ≥3. 13 patients in our study died, out of which 12 patients had BISAP score ≥3. We also found that a BISAP score of ≥3 had a sensitivity of 92%, specificity of 76%, a positive predictive value of 17%, and a negative predictive value of 99% for mortality.DiscussionThe BISAP score is a simple and accurate method for the early identification of patients at increased risk for in hospital mortality and morbidity.     

新亚特兰大分类下不同评分标准预测急性胰腺炎预后的价值比较

目的 采用基于新亚特兰大分类的急性胰腺炎(AP)定义,比较急性胰腺炎严重程度床边指数(BISAP)、急性生理与慢性健康评分Ⅱ(APACHEⅡ)和Ranson评分对AP患者死亡和持续性器官功能不全的预测价值.方法 回顾性分析前瞻性收集的2009年11月-2012年1月在南昌大学第一附属医院住院的连续AP患者资料350例,其中完成随访的310例纳入本研究,年龄(50.5±16.4)岁.将其分为起病至就诊时间≤7 d组(发病早期)和＞7d组(发病后期).计算患者入院后前3d各评分系统的分值.治疗并随访患者至腹痛消失、血淀粉酶正常.比较3种评分系统预测患者持续性器官功能不全及死亡的接受者操作特征曲线下面积(AUCROC),并计算3种评分预测的最佳阈值、灵敏度、特异度和约登指数.结果 (1)入院第1天BISAP评分、APACHEⅡ评分和入院48 h的Ranson评分预测持续性器官功能不全及死亡的价值中等(AUCRoC0.68 ～0.84),3者比较差异无统计学意义(P值均＞0.05).但3种评分系统对就诊时间＞7d组患者预后的预测均无统计学意义(P值均＞0.05).(2)入院后前3d中,每天的BISAP和APACHEⅡ评分对AP患者预后都有中或高度的预测价值,但各天的预测价值的差异无统计学意义(P值均＞0.05).结论 此3种临床评分系统对新亚特兰大分类下的AP预后预测价值中等,且只适合在发病早期使用.新提出的BISAP评分虽不优于传统的Ranson评分和APACHEⅡ评分,但其使用简便,值得推广.入院后连续3d的动态评分并不能提高APACHEⅡ和BISAP评分对AP预后的预测价值.     

Value of the different prognostic systems and biological markers for predicting severity and progression of acute pancreatitis

Abstract

Objective. Several tools have been developed for severity stratification in acute pancreatitis (AP). They include single biochemical markers and complex scoring systems, all of which aim at an early detection of severe AP to optimize monitoring and treatment of these patients. The aim of this study was to reassess and compare the value of some known and newly-introduced prognostic markers in the clinical context. Material and Methods. We have conducted a prospective observational study. One hundred and eight patients with a diagnosis of AP and onset of the disease within last 72 h were included in this study. Clinical data and expression results of some serum biochemical markers were used for statistical analysis. The diagnostic performance of scores predicting severity and progression of AP, cut-off values, specificity, and sensitivity were established using receiver operating characteristic curve analysis. Results. Among single biochemical markers, C-reactive protein remains the most useful. Despite its delayed increase, it is accurate, cheap, and widely available. Interleukin-6 and macrophage migration inhibitory factor seem to be new promising parameters for use in clinical routine. Pancreas specific scores (Imrie-Glasgow, pancreatitis outcome prediction) and scores assessing organ dysfunction (acute physiology and chronic health evaluation II, multiple organ dysfunction score, and Marshall score) remain of value in determining the severity, complications, and possible outcome of AP. Conclusions. Indication, timing, and consequences of the methods applied need to be carefully considered and incorporated into clinical assessments. Currently, there is no single prognostic marker that would cover the whole range of problems associated with the treatment of AP. The prediction of severity and progression of AP can be achieved using a series of accurate methods. The decision to undertake interventional or surgical treatment is the most complex task requiring both clinical judgment and meticulous monitoring of the patient.     

Comparison between Society of Thoracic Surgeons Score and logistic EuroSCORE for predicting mortality in patients referred for transcatheter aortic valve implantation

Background

The primary inclusion criteria from both the Society of Thoracic Surgeons (STS) score and the logistic EuroSCORE are currently used to identify high-risk and inoperable patients eligible for transcatheter aortic valve implantation (TAVI). We aimed to examine the correlation between STS and logistic EuroSCOREs and their performance characteristics in patients referred for TAVI.

Methods

The study cohort consisted of 718 high-risk patients with severe aortic stenosis who were considered for participation in a TAVI clinical trial. The performance of the STS and logistic EuroSCOREs was evaluated in three groups: (a) medical management or balloon aortic valvuloplasty (BAV), 474 (66%); (b) 133 patients (18.5%) with surgical aortic valve replacement (AVR); (c) 111 (15.4%) with TAVI. The mean age was 81.8±8.1 years, and 394 (54.8%) were female.

Results

The mean STS score was 11.5±6.1, and the mean logistic EuroSCORE was 39.7±23.0. Pearson correlation coefficient showed moderate correlation between the STS and logistic EuroSCOREs (r=0.61, P<.001). At a median follow-up of 190 days (range, 67–476), 282 patients (39.2%) died. The STS and logistic EuroSCOREs were both higher in patients who died as compared to those in survivors (13.1±6.2 vs.10.0±5.8 and 43.4±23.1 vs. 37.5±22, respectively; P<.001). The observed and predicted 30-day mortality rates in the medical/BAV group were 10.1% observed, 12.3% by STS and 43.1% by logistic EuroSCORE. In the surgical AVR group, the rates were 12.8% observed, 8.4% by STS and 25.6% by logistic EuroSCORE. In the TAVI group, the rates were 11.7% observed, 11.8% by STS and 41.2% by logistic EuroSCORE. The odds ratio (OR) for 30-day mortality in the medical/BAV group was 1.05 (P=.01) with STS and 1.003 (P=.7) with logistic EuroSCORE. In the surgical AVR group, the OR was 1.09 (P=.07) with STS and 1.007 (P=.6) with logistic EuroSCORE. In the TAVI group, the OR was 1.14 (P=.03) with STS and 1.03 (P=.04) with logistic EuroSCORE.

Conclusion

In high-risk patients with severe aortic stenosis, STS score is superior to the logistic EuroSCORE in predicting mortality. Clinical judgment should play a major role in the selection of patients with severe aortic stenosis for the different therapeutic options.     

BISAP评分系统对重症急性胰腺炎的评估价值

目的 探讨新型BISAP评分体系(bedside index for severity in AP)对重症急性胰腺炎(SAP)的评估价值。方法 选取临床拟诊为SAP的患者68例,分别进行BISAP、APACHEⅡ、Ranson以及CTSI评分。BISAP评分标准包括患者入院24h内的尿素氮水平、受损精神状态、全身炎症反应综合征、年龄、胸腔积液5项内容。以BISAP≥3分、APACHEⅡ≥8分、Ranson≥3分、CTSI≥3分为SAP的评估标准,分析这几种评分系统评估SAP的正确率。结果 68例患者中,BISAP≥3分者43例,占63.2％;APACHEⅡ≥8分者41例,占60.3％;Ranson≥3分者41例,占60.3％;CTSI≥3分者46例,占67.6％。BISAP评分系统与APACHEⅡ评分系统、Ranson评分系统以及CTSI评分系统比较,评估SAP的正确率均无显著性统计学差异。结论 BISAP评分系统作为一种新型的、简便的评分体系可推广应用于SAP的评估。     

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     

Increasing the low residue diet to 3 days does not improve the bowel cleansing in hard to prepare patients: Post hoc analysis of a randomized controlled trial

BackgroundRecent evidence suggests that the number of low residue diet (LRD) days does not influence the bowel cleansing quality in non-selected patients. However, there are not data in the subgroup of patients with risk factors of inadequate bowel cleansing.ObjectiveThe aim of this study was to assess whether a 3-day LRD improved the bowel cleansing quality in patients with risk factors of poor bowel cleansing.Patients and methodsPost hoc analysis of a randomized controlled trial carried out between December 2017 and March 2018 in a tertiary care hospital. Patients with high risk of poor bowel cleansing were selected following a validated score. The patients were randomized to the 1-day LRD or 3-day LRD groups. All patients received a 2-L split-dose of polyethylene glycol plus ascorbic acid. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the main outcome.Results135 patients (1-day LRD group = 67, 3-day LRD = 68) were included. The rate of adequate cleansing quality was not significantly different between the groups in the ITT analysis: 76.1%, 95% CI: [64.6–84.8] vs. 79.4%, 95% CI: [68.2–87.4]; odds ratio (OR) 1.2, 95% CI [0.54–2.73]) or in the PP analysis: 77.3%, 95% CI: [65.7–85.8] vs. 80.3%, 95% CI: [69.0–88.3]; OR 1.2, 95% CI [0.52–2.77]). Compliance with the diet or cleansing solution, satisfaction or difficulties with the LRD and the polyp/adenoma detection rates were not significantly different.ConclusionOur results suggest that 1-day LRD is not inferior to 3-day LRD in patients with risk factors of inadequate bowel cleansing.     

Neutrophil,lymphocyte and platelet ratio as a predictor of mortality in septic-acute kidney injury patients

BackgroundAKI is frequent in critically ill patients, in whom the leading cause of AKI is sepsis. The role of intrarenal and systemic inflammation appears to be significant in the pathophysiology of septic-AKI. The neutrophils to lymphocytes and platelets (N/LP) ratio is an indirect marker of inflammation. The aim of this study was to evaluate the prognostic ability of N/LP ratio at admission in septic-AKI patients admitted to an intensive care unit (ICU).MethodsThis is a retrospective analysis of 399 septic-AKI patients admitted to the Division of Intensive Medicine of the Centro Hospitalar Universitário Lisboa Norte between January 2008 and December 2014. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. N/LP ratio was calculated as: (Neutrophil count × 100)/(Lymphocyte count × Platelet count).ResultsFifty-two percent of patients were KDIGO stage 3, 25.8% KDIGO stage 2 and 22.3% KDIGO stage 1. A higher N/LP ratio was an independent predictor of increased risk of in-hospital mortality in septic-AKI patients regardless of KDIGO stage (31.59 ± 126.8 vs 13.66 ± 22.64, p = 0.028; unadjusted OR 1.01 (95% CI 1.00–1.02), p = 0.027; adjusted OR 1.01 (95% CI 1.00–1.02), p = 0.015). The AUC for mortality prediction in septic-AKI was of 0.565 (95% CI (0.515–0.615), p = 0.034).ConclusionsThe N/LP ratio at ICU admission was independently associated with in-hospital mortality in septic-AKI patients.