急性胰腺炎不同评分体系在新分类标准中的再评价

目的重新评价BISAP、APACHEⅡ、CTSI等评分体系对急性胰腺炎(acute pancreatitis,AP)新分类内重度急性胰腺炎(severe acute pancreatitis,SAP)的评价价值。方法收集2013年9月至2014年10月北京协和医院收治的136例AP患者临床资料及入院BISAP、CTSI、APACHEⅡ、SIRS、Glasgow、Ranson评分,评估各评分体系与新分类的相关性,用ROC曲线分析各评分预测病情严重程度的准确性,并评价其对预后的判断价值。结果 (1)136例AP患者中,轻度急性胰腺炎组50例(36.8%),中度重症胰腺炎组61例(44.9%),重症胰腺炎组25例(18.4%)。(2)BISAP、APACHEⅡ、CTSI评分与疾病严重程度相关(P0.05)。(3)BISAP、APACHEⅡ和CTSI评分对新分类中SAP预测准确性AUC值分别为0.904、0.942和0.823,最佳预测值分别为3分(敏感度84%,特异度86.5%,阳性似然比6.216,阴性似然比0.185)、10分(敏感度96%,特异度86.5%,阳性似然比7.104,阴性似然比0.046)和4分(敏感度96%,特异度56.8%,阳性似然比2.220,阴性似然比0.070)。(4)BISAP评分与疾病复发相关(P0.05)。结论 BISAP、APACHEⅡ、CTSI评分与新分类相关性较好,其中BISAP、APACHEⅡ评分对SAP的预测最为准确,BISAP≥3分或APACHEⅡ≥10分提示SAP。     

APACHE Ⅱ、Ranson和CT评分系统对重症急性胰腺炎预后评价的比较

目的 比较APACHE Ⅱ、Ranson和CT 3种临床常用评分系统对重症急性胰腺炎(SAP)预后指标的预测作用.方法 回顾分析1993年1月～ 2004年1月收治的201例SAP患者.记录资料包括24 h APACHE Ⅱ评分、48 h APACHE Ⅱ评分、48 h Ranson评分和72 h CT评分.预后指标包括:胰腺坏死程度、局部并发症、感染、器官衰竭、外科引流、死亡率、禁食天数和住院天数.应用ROC曲线下面积(AUC)检验各评分数据对预后预测的价值.结果 通过比较AUC,在预测器官衰竭和禁食天数方面,APACHE Ⅱ(48 h)具有优越性.在预测局部并发症,禁食天数以及住院天数方面,Ranson评分相对较好.较之其他评分系统,CT评分在预测胰腺坏死和外科引流方面有较大优势.结论 对上述8个预测指标,几种评分系统的评价预测能力不相同.应当联合应用几种评分系统评价SAP患者的预后.     

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.     

不同评分系统在老年急性胰腺炎患者中的比较研究

背景:老年急性胰腺炎(AP)具有病情重、并发症多、死亡率高等特点,早期识别和预测病情对及时诊治老年AP患者具有重要意义。目的:探讨Ranson、BISAP和APACHEⅡ评分系统对老年AP患者的病情严重程度、并发症以及预后的预测价值。方法:纳入2012年7月—2016年6月武汉大学人民医院收治的318例老年AP患者,分别评估Ranson、BISAP、APACHEⅡ评分。应用受试者工作特征曲线(ROC曲线)评估不同评分系统对老年AP患者病情严重程度、并发症、预后的预测价值。结果:在318例老年AP患者中,轻度AP患者221例,中度41例,重度56例。51例患者伴有局部并发症,64例伴有全身并发症。治疗总有效率为96. 2%。APACHEⅡ评分预测老年AP患者的病情严重程度、全身并发症、疗效、ICU住院率、死亡率的AUC显著高于Ranson、BISAP评分,而三种评分系统预测局部并发症的AUC无明显差异(P 0. 05)。结论:APACHEⅡ评分对老年AP患者的病情严重程度、全身并发症、疗效、ICU住院率和死亡率的预测能力最强,而在局部并发症的预测方面,三种评分系统无明显差异。     

改良客观性BISAP评分对急性胰腺炎严重程度及预后的预测价值

目的探讨改良客观性BISAP评分(MBISAP)对急性胰腺炎(AP)严重程度及预后的预测价值。方法回顾性分析2018年6月—2020年6月川北医学院附属医院收治的313例AP患者资料,将BISAP评分中精神状态这一主观性指标去除,再根据CTSI(CT严重指数)评分标准,将胰腺坏死程度分为4类(0、0～30%、30%～50%、 50%),并给予相应的赋值(0～3分),MBISAP评分由上述指标赋值相加可得,最高为7分。根据受试者工作特征(ROC)曲线将313例胰腺炎患者分为MBISAP低级别组(MBISAP 3分)和MBISAP高级别组(MBISAP≥3分) 2组。比较2组基线资料、临床结局,非正态分布的计量资料2组间比较采用MannWhitney U秩和检验;计数资料2组间比较采用χ~2检验或Fisher精确检验。ROC曲线下面积(AUC)分析比较MBISAP评分、BISAP评分、CTSI评分对AP病情严重程度、预后的预测价值。结果 2组患者在年龄(Z=-5.480,P 0.001)、病因(χ~2=36.536,P 0.001)、住院时间(Z=-6.038,P 0.001)、病死率(P 0.001)、胰周感染(P 0.001)、多器官功能障碍综合征(MODS)(P 0.001)、BISAP评分(χ~2=215.320,P 0.001)、CTSI评分(P 0.001)之间存在明显差异。随着MBISAP评分的增加,AP病情严重程度、病死率、胰周感染、MODS的发生呈增加趋势(P值均0.001)。在预测SAP方面,MBISAP评分AUC=0.898(95%CI:0.859～0.929,P 0.001),敏感度为71.43%,特异度为90.53%;当MBISAP≥3时为最佳临界值,优于BISAP评分(AUC=0.868,P 0.05)、CTSI评分(AUC=0.827,P 0.05)。在预测AP患者死亡方面,MBISAP评分AUC=0.925 (95%CI:0.890～0.952,P 0.001),敏感度为88.89%,特异度为82.89%;当MBISAP≥3时为最佳临界值,与BISAP评分(AUC=0.915,P 0.05)、CTSI评分(AUC=0.879,P 0.05)相似。在预测AP胰周感染方面,MBISAP评分AUC=0.842(95%CI:0.796～0.880,P 0.001),敏感度为72.22%,特异度为84.07%;当MBISAP 2时为最佳临界值,优于BISAP评分(AUC=0.776,P 0.05),但比CTSI评分(AUC=0.932,P 0.05)较差。在预测AP患者合并MODS方面,MBISAP评分AUC=0.874(95%CI:0.832～0.909,P 0.001),敏感度为76.19%,特异度为84.93%,当MBISAP 2时为最佳临界值,与BISAP评分(AUC=0.855,P 0.05)、CTSI评分(AUC=0.829,P0.05)相似。结论 MBISAP评分在预测AP患者的严重程度及胰周感染方面优于BISAP评分,预测AP患者死亡及MODS方面也有较好的价值,相比BISAP评分能够更准确、客观地评估AP患者情况。     

CT严重指数、Ransons评分及超声造影严重指数评估急性胰腺炎病情

背景常规超声在急性胰腺炎(acute pancreatitis, AP)病情判断中较为重要,但对胰腺坏死病灶的判断较为困难.超声造影能敏感显示胰腺组织的微循环灌注状态,实时反映胰腺组织的缺血坏死区域,有助于提高超声诊断重症AP的准确率.目的运用超声造影评估AP病情,探讨超声造影严重指数(ultrasound severity indices,USSI)与CT严重指数(CT severity indices, CTSI)、Ransons评分的相关性.方法选取我院收治的67例AP患者作为研究对象.所有患者入院3d内行胰腺增强CT和超声造影检查,记录CTSI、USSI,并行Ransons评分,分析USSI与CTSI、Ransons评分的相关性.结果超声造影对胰腺坏死灶的检出率为93.81%;超声造影判定重型AP的敏感度=88.46%、特异度=95.12%、准确度=92.54%;重型AP患者的USSI、CTSI、Ransons评分明显高于轻型A P患者,差异有统计学意义(P0.05); USSI与CTSI呈正相关(r=0.95, P 0.05);USSI与Ransons评分呈正相关(r=0.75,P 0.05).结论超声造影能有效发现AP坏死灶,准确评估AP严重程度,其USSI与CTSI、Ransons评分相关性良好,可为临床评估病情及预后提供参考.     

CT和临床评分对急性胰腺炎早期预测评估的比较研究

目的:研究比较早期急性胰腺炎(AP)应用临床评分和CT进行预测评估的价值.方法:抽取60例患者,调取时间为2019.01～2021.10范围,均确诊为AP,按照病情严重程度分组,其中40例为轻症AP(MAP)设为对比组,另20例为重症AP(SAP)设为分析组.2组均实施CT检查,评估腹部CT胰腺外炎症(EPIC)、Ba...     

三种评分标准对急性胰腺炎病情和预后的评估作用

目的 探讨Ranson、CT严重指数(CTSI)和急性胰腺炎严重程度床边指数(BISAP)三种评分系统在判断急性胰腺炎(AP)病情和预后中的价值.方法 回顾性分析2008年1月至2011年4月共计503例确诊AP患者,包括轻症急性胰腺炎(MAP) 356例,重症急性胰腺炎(SAP)147例,应用受试者工作特征(ROC)曲线比较Ranson、CTSI和BISAP评分系统对AP病情严重度的评估价值和对病情预后的预测价值.将SAP分为无脏器功能衰竭组和脏器功能衰竭组,比较3种评分系统对AP并发脏器功能衰竭的预测价值.结果 MAP组和SAP组间的Ranson、CTSI和BISAP评分分值差异均有统计学意义(x2分别为236.88、126.24和101.27,P＜0.01),Ranson评分系统的敏感度(97.3％)和ROC曲线下面积(AUC)值(0.92)最大.在147例SAP患者的无脏器功能衰竭组和脏器功能衰竭组中,Ranson和BISAP评分的差异均有统计学意义(x2分别为17.67和26.12,P＜0.01),敏感度均为100％,特异度分别为96％和85％,BISAP评分的AUC值最大(0.80).在病情改善组和病情恶化组,Ranson和BISAP评分的分值差异具有统计学意义(x2分别为9.53和10.19,P＜0.05),BISAP评分系统的AUC值最大(0.74).结论 3种评分系统均可用于判断AP病情的严重程度.对于SAP并发脏器功能衰竭的风险和预后的判断,BISAP评分优于Ranson评分.BISAP评分简便、易行,为AP临床病情的判断提供了重要手段.     

尿微量白蛋白在急性胰腺炎预后判断中的价值

112例急性胰腺炎(AP)患者分别用胰腺炎CT严重指数(CTSI)评价胰腺损伤程度,APACHEⅡ评价病情严重程度,Logisic器官功能障碍评分系统(LODS)评价器官功能衰竭程度,分析尿微量白蛋白(MA)与三种评分之间的相关性,比较尿MA的动态变化[第一个48 h内尿微量白蛋白与尿肌酐比值(ACR)的变化(△ACR)]与PAPCHE Ⅱ评分和LODS评分对ICU内AP患者病死率的预测价值.结果 显示,患者人ICU时MAU率出现为96.1%;第48 h △ACR增高患者病死率(64.3%)与未增高者(15.1%)比较,P＜0.05.△ACR与PAPCHE Ⅱ评分、LODS评分和△LODS呈正相关(r分别为0.402、0.301、0.627,P均＜0.05),△ACR预测AP患者ICU内死亡的敏感性和特异性分别为83.3%和84.9%;△ACR、APPCHE Ⅱ及LODS评分对于ICU内死亡预测的受试者工作特征曲线下面积(AUROC)分别为0.859、0.859、0.827.认为急性AP患者MAU发生率较高,尿MA的持续增高提示AP患者在ICU内的病死率和器官功能障碍发生率较高;检测尿MA可作为判断ICU内AP患者预后的一个早期预测指标.     

不同评分系统对判断急性胰腺炎病情及预后的比较研究

目的比较PANC3、SIRSS、HAPS、Ranson’s、CTSI评分对急性胰腺炎(acute pancreatitis,AP)病情严重程度的评估价值,为AP诊治、改善预后提供临床依据。方法回顾性分析昆明医科大学第二附属医院消化内科2013年1月至2016年12月收治的121例AP患者临床资料,计算PANC3、SIRSS、HAPS、Ranson’s、CTSI评分,绘制受试者工作特征曲线(ROC),比较各评分对SAP、局部并发症、全身并发症、死亡的预测价值。结果 MAP组、MSAP组及SAP组5种评分均数比较,差异均有统计学意义(P均0.05),SAP组分值显著高于MAP组及MSAP组;PANC3、SIRSS、HAPS、Ranson’s、CTSI评分与AP病情严重程度有显著相关性(P0.05),HAPS评分与SAP无相关性(P0.05),HAPS评分预测MAP的准确度为90.5%。对预测SAP方面,PANC3评分AUC值、约登指数、敏感度高于其他评分。在预测AP局部并发症方面,CTSI评分AUC值、约登指数、敏感度和特异度高于其他评分。在预测AP全身并发症和死亡方面,Ranson’s评分AUC值、约登指数均高于其他评分。在评估局部并发症、全身并发症、死亡的发生率方面,PANC3≥2分、SIRSS≥2分、Ranson’s≥3分、CTSI≥4分组所占例数均显著高于PANC32分、SIRSS2分、Ranson’s3分、CTSI4分组。结论 Ranson’s评分对预测AP全身并发症和死亡率的诊断价值及准确度高于其他评分,在预测AP局部并发症中CTSI评分诊断价值有显著优势,PANC3评分对预测SAP诊断价值优于其他评分,HAPS对评价MAP准确度更高。     

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.     

The revised Atlanta criteria 2012 altered the classiifcation,severity assessment and management of acute pancreatitis

BACKGROUND: The Atlanta criteria for acute pancreatitis (AP) has been revised recently. This study was to evaluate its practical value in classiifcation of AP, the severity assessment and management.
METHODS: The clinical features, severity classiifcation, out-come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria (RAC) and the original Atlanta criteria (OAC).
RESULTS: Compared to the OAC group, the incidence of se-vere acute pancreatitis (SAP) was decreased by approximately one half (13.9% vs 28.2%) in the RAC group. The RAC present-ed a lower sensitivity but higher speciifcity, and its predictive value for severity and poor outcome was higher than those of the OAC. The proportion of SAP diagnosis and ICU admission in the early phase in the RAC group was signiifcantly lower than that in the OAC group (P<0.05). Based on the RAC, the risk factors for death among SAP patients were older age, high CT severity index (CTSI), renal failure, cardiovascular failure, acute necrotic collection and walled-off necrosis. Compared to the OAC, the acute physiology and chronic health evalua-tion II (APACHE II) score, Ranson score, idiopathic etiology, respiratory failure and laparotomy debridement were not risk factors of death in contrast to walled-off necrosis. Interest-ingly, hypertriglyceridemia-related SAP had good outcomes in both groups.
CONCLUSIONS: The RAC showed a higher predictive value for severity and poorer outcome than the OAC. However, the RAC resulted in fewer ICU admissions in the early phase due to its lower sensitivity for diagnosis of SAP. Among SAP cases, older age, high CTSI, renal and cardiovascular failure, com-plications of acute necrotic collection and walled-off necrosis were independent risk factors for mortality.     

The revised Atlanta criteria 2012 altered the classification,severity assessment and management of acute pancreatitis

BACKGROUND:The Atlanta criteria for acute pancreatitis(AP) has been revised recently.This study was to evaluate its practical value in classification of AP,the severity assessment and management.METHODS:The clinical features,severity classification,outcome and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria(RAC) and the original Atlanta criteria(OAC).RESULTS:Compared to the OAC group,the incidence of severe acute pancreatitis(SAP) was decreased by approximately one half(13.9% vs 28.2%) in the RAC group.The RAC presented a lower sensitivity but higher specificity,and its predictive value for severity and poor outcome was higher than those of the OAC.The proportion of SAP diagnosis and ICU admission in the early phase in the RAC group was significantly lower than that in the OAC group(P0.05).Based on the RAC,the risk factors for death among SAP patients were older age,high CT severity index(CTSI),renal failure,cardiovascular failure,acute necrotic collection and walled-off necrosis.Compared to the OAC,the acute physiology and chronic health evaluation II(APACHE II) score,Ranson score,idiopathic etiology,respiratory failure and laparotomy debridement were not risk factors of death in contrast to walled-off necrosis.Interestingly,hypertriglyceridemia-related SAP had good outcomes in both groups.CONCLUSIONS:The RAC showed a higher predictive value for severity and poorer outcome than the OAC.However,the RAC resulted in fewer ICU admissions in the early phase due to its lower sensitivity for diagnosis of SAP.Among SAP cases,older age,high CTSI,renal and cardiovascular failure,complications of acute necrotic collection and walled-off necrosis were independent risk factors for mortality.     

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联合凝血指标对急性胰腺炎严重程度评估的意义

目的:研究BISAP(bedside index for severity in AP)评分联合凝血指标对急性胰腺炎(acute pancreatitis,AP)严重程度评估的意义.方法:回顾2008-2012年中国医科大学附属盛京医院收治的166例AP患者的临床资料.对所有患者进行入院24h的BISAP、APACHE-Ⅱ评分,48h的Ranson’s及发病72h内CTSI评分,入院24h内抽取静脉血测定部分凝血活酶活化时间、凝血酶原时间、D-二聚体(D-dimer)、纤维蛋白原及血小板水平.分析凝血指标及BISAP评分对AP严重程度判断的意义,并通过ROC曲线分析二者联合对AP严重程度评估的意义.结果:多因素Logistic回归分析发现,D-dimer对AP严重程度评估具有独立预测意义;随着BISAP评分增加,SAP的比率增加;BISAP评分系统评估AP严重程度以2为临界点时Youden指数最大(0.541),ROC曲线下面积为0.836(0.776-0.896),并不逊于传统评分系统;BISAP评分系统联合D-dimer能更好地评估AP患者的严重程度.结论:BISAP是临床判断AP轻重程度的简单有效的指标,将BISAP与D-dimer联合应用使得对AP严重程度的评估更为准确.     

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.     

Comparison of Existing Clinical Scoring Systems in Predicting Severity and Prognoses of Hyperlipidemic Acute Pancreatitis in Chinese Patients: A Retrospective Study

It is important to identify the severity of acute pancreatitis (AP) in the early course of the disease. Clinical scoring systems may be helpful to predict the prognosis of patients with early AP; however, few analysts have forecast the accuracy of scoring systems for the prognosis in hyperlipidemic acute pancreatitis (HLAP). The purpose of this study was to summarize the clinical characteristics of HLAP and compare the accuracy of conventional scoring systems in predicting the prognosis of HLAP.This study retrospectively analyzed all consecutively diagnosed AP patients between September 2008 and March 2014. We compared the clinical characteristics between HLAP and nonhyperlipidemic acute pancreatitis. The bedside index for severity of acute pancreatitis (BISAP), Ranson, computed tomography severity index (CTSI), and systemic inflammatory response syndrome (SIRS) scores were applied within 48 hours following admission.Of 909 AP patients, 129 (14.2%) had HLAP, 20 were classified as severe acute pancreatitis (SAP), 8 had pseudocysts, 9 had pancreatic necrosis, 30 had pleural effusions, 33 had SIRS, 14 had persistent organ failure, and there was 1 death. Among the HLAP patients, the area under curves for BISAP, Ranson, SIRS, and CTSI in predicting SAP were 0.905, 0.938, 0.812, and 0.834, 0.874, 0.726, 0.668, and 0.848 for local complications, and 0.904, 0.917, 0.758, and 0.849 for organ failure, respectively.HLAP patients were characterized by younger age at onset, higher recurrence rate, and being more prone to pancreatic necrosis, organ failure, and SAP. BISAP, Ranson, SIRS, and CTSI all have accuracy in predicting the prognosis of HLAP patients, but each has different strengths and weaknesses.     

Correlation between procalcitonin and intra-abdominal pressure and their role in prediction of the severity of acute pancreatitis

Background/aimsEarly assessment of disease severity and vigilant patient monitoring are key factors for adequate treatment of acute pancreatitis (AP). The aim of this study was to determine the correlation of procalcitonin (PCT) serum concentrations and intra-abdominal pressure (IAP) as prognostic markers in early stages of AP.MethodsThis prospective observational study included 51 patients, of which 29 had severe AP (SAP). Patients were evaluated with the Acute Physiology And Chronic Health Evaluation (APACHE II) score, C-reactive protein (CRP) and PCT serum concentrations and IAP at 24 h from admission. PCT was measured three times in the 1st week of disease and three times afterward, while IAP was measured daily. PCT and IAP values correlated with each other, and also compared with APACHE II score and CRP values.ResultsPCT, IAP, CRP values and APACHE II score at 24 h after hospital admission were significantly elevated in patients with SAP. There was significant correlation between PCT and IAP values measured at 24 h of admission, and between maximal PCT and IAP values. Sensitivity/specificity for predicting AP severity at 24 h after admission was 89%/69% for APACHE II score, 75%/86% for CRP, 86%/63% for PCT and 75%/77% for IAP.ConclusionsIncreased IAP was accompanied by increased PCT serum concentration in patients with AP. PCT and IAP can both be used as early markers of AP severity.     

急性胰腺炎多层螺旋CT灌注参数与临床病情评估系统的关系研究

目的 探讨急性胰腺炎(AP)患者胰腺CT灌注的变化以及与临床常用AP病情评估系统的关系,评价CT灌注参数的临床应用价值.方法 2006年8月至2008年4月行胰腺CT灌注成像120例,其中正常胰腺34例,AP患者86例.采用德国Siemens somatom Sensation 64层螺旋CT进行灌注扫描,获取灌注参数血流量(BF)、血容量(BV)、峰值时间(TTP)和表面通透性(PS),并与APACHEⅡ评分、Ranson评分、CRP、CTSI、腹痛缓解时间、住院天数、局部并发症发生率进行相关性分析.结果 AP组平均BF、BV、TTP、PS分别为(113.57±50.04)ml·100 ml~(-1)·min~(-1)、(146.61±45.11)ml/L、(148.88±21.16)0.1 s、(119.53±52.36)0.5 ml·100 ml~(-1)·min~(-1),与正常对照组相比,BF、BV明显下降(P<0.05),TTP、PS变化无统计学意义.AP患者的CT灌注参数BF、BV与APACHEⅡ评分、Ransont评分、CRP、CTSI存在相关性(P<0.05),与腹痛缓解时间、住院天数、局部并发症发生率也存在相关性(P<0.05).结论 AP患者胰腺血流灌注降低,灌注参数BV、BF与临床常用AP病情评估系统存在相关关系,提示CT灌注成像在AP病情评估中具有良好的临床应用前景.     

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.