Published online Sep 7, 2022. doi: 10.3748/wjg.v28.i33.4846
Peer-review started: June 12, 2022
First decision: July 12, 2022
Revised: July 25, 2022
Accepted: August 16, 2022
Article in press: August 16, 2022
Published online: September 7, 2022
The frequency of acute hypertriglyceridemic pancreatitis (AHTGP) is increasing worldwide. AHTGP may be associated with a more severe clinical course and greater mortality than pancreatitis caused by other causes. Early identification of patients with severe inclination is essential for clinical decision-making and improving prognosis. Therefore, we first developed and validated a risk predic
To develop and validate a risk prediction score for the severity of AHTGP in Chinese patients.
We performed a retrospective study including 243 patients with AHTGP. Patients were randomly divided into a development cohort (n = 170) and a validation cohort (n = 73). Least absolute shrinkage and selection operator and logistic regression were used to screen 42 potential predictive variables to construct a risk score for the severity of AHTGP. We evaluated the performance of the nomogram and compared it with existing scoring systems. Last, we used the best cutoff value (88.16) for severe acute pancreatitis (SAP) to determine the risk stratification classification.
Age, the reduction in apolipoprotein A1 and the presence of pleural effusion were independent risk factors for SAP and were used to construct the nomogram (risk prediction score referred to as AAP). The concordance index of the nomogram in the development and validation groups was 0.930 and 0.928, respectively. Calibration plots demonstrate excellent agreement between the predicted and actual probabilities in SAP patients. The area under the curve of the nomogram (0.929) was better than those of the Bedside Index of Severity in AP (BISAP), Ranson, Acute Physiology and Chronic Health Evaluation (APACHE II), modified computed tomography severity index (MCTSI), and early achievable severity index scores (0.852, 0.825, 0.807, 0.831 and 0.807, respectively). In comparison with these scores, the integrated discrimination improvement and decision curve analysis showed improved accuracy in predicting SAP and better net benefits for clinical decisions. Receiver operating characteristic curve analysis was used to determine risk stratification classification for AHTGP by dividing patients into high-risk and low-risk groups according to the best cutoff value (88.16). The high-risk group (> 88.16) was closely related to the appearance of local and systemic complications, Ranson score ≥ 3, BISAP score ≥ 3, MCTSI score ≥ 4, APACHE II score ≥ 8, C-reactive protein level ≥ 190, and length of hospital stay.
The nomogram could help identify AHTGP patients who are likely to develop SAP at an early stage, which is of great value in guiding clinical decisions.
Core Tip: A risk prediction score (referred to as AAP), including age, the level of apolipoprotein A1 and the presence of pleural effusion, was first built to predict the severity of acute hypertriglyceridemic pancreatitis in Chinese patients. After calibration and verification, this score was shown to have high predictive accuracy and good performance. The risk score could help identify patients who are likely to develop severe acute pancreatitis at an early stage. In comparison with other scores, these scores showed improved accuracy in predicting and better net benefits for clinical decisions. AAP could be of great value in guiding clinical decisions as a convenient and specific tool.