Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2022; 28(33): 4846-4860
Published online Sep 7, 2022. doi: 10.3748/wjg.v28.i33.4846
Development and validation of a risk prediction score for the severity of acute hypertriglyceridemic pancreatitis in Chinese patients
Zi-Yu Liu, Lei Tian, Xiang-Yao Sun, Zong-Shi Liu, Li-Jie Hao, Wen-Wen Shen, Yan-Qiu Gao, Hui-Hong Zhai
Zi-Yu Liu, Li-Jie Hao, Wen-Wen Shen, Yan-Qiu Gao, Hui-Hong Zhai, Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Lei Tian, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Los Angeles, CA 91010, United States
Xiang-Yao Sun, Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Zong-Shi Liu, Department of Geriatric, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong Province, China
Author contributions: Liu ZY and Zhai HH designed the current study as the principal investigators; Liu ZY and Tian L were involved in the study conception and design; Hao LJ, Shen WW and Gao YQ collected data; Liu ZY, Sun XY and Liu ZS drafted the plans for the data analyses, conducted statistical analyses and interpreted the data; Liu ZY drafted the manuscript; Tian L was responsible for language editing; All authors were involved in interpretation of the results and revision of the manuscript, and all approved the final version of the manuscript, the corresponding author attests that all the listed authors meet the authorship criteria and that no others meeting the criteria have been omitted.
Supported by 2021 National Natural Youth Cultivation Project of Xuanwu Hospital of Capital Medical University, No. QNPY2021018.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Xuanwu Hospital of Capital Medical University, No. 2022102.
Informed consent statement: Written informed consent was waived considering the retrospective study design.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The clinical data was available from the corresponding author at zhaihuihong@263.net. And no additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Hong Zhai, MD, PhD, Chief Physician, Doctor, Professor, Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing 100053, China. zhaihuihong@263.net
Received: June 12, 2022
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
Processing time: 80 Days and 6.1 Hours
ARTICLE HIGHLIGHTS
Research background

The frequency of acute hypertriglyceridemic pancreatitis (AHTGP) is in-creasing 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 deci-sion-making and improving prognosis. Hence, constructing a risk prediction score with high predictive accuracy and clinical utility for assessing the severity of AHTGP patients is of great importance.

Research motivation

Early prediction and detection of AHTGP patients who are likely to develop severe acute pancreatitis (SAP) is of great importance. Almost of existing clinical scores were developed for all etiologies of pancreatitis and not for hypertriglyceridemia (HTG)-induced pancreatitis separately. To the best of our knowledge, this is the first study attempting to develop a risk prediction score for HTG-induced pancreatitis. This risk score may help guide clinical decisions for these patients.

Research objectives

The purpose of this study was to establish a risk prediction score with easy use and high performance for predicting the severity of AHTGP patients in China, which will help doctors make rational clinical decisions.

Research methods

We performed a retrospective study of patients with AHTGP. Least absolute shrinkage and selection operator and logistic regression were used to screen predictive variables to construct a nomogram for predicting the severity of AHTGP. The predictive accuracy of the nomogram was estimated using the concordance index. The performance of the nomogram was estimated using a calibration curve. We evaluated the predictive accuracy and net benefit of the risk score and compared it with existing scoring systems via receiver operating characteristic curve analysis and decision curve analysis. We used the best cutoff value for SAP to determine the risk stratification classification.

Research results

A risk prediction score consisting of three predictors commonly measured on admission was constructed to predict the severity of SAP. More importantly, our nomogram exhibited high predictive accuracy and good performance. In addition, our nomogram has shown improved prognostic reliability, accuracy and the best net benefit when compared to other clinical scoring systems, such as Bedside Index of Severity in AP, Ranson, Acute Physiology and Chronic Health Evaluation II, modified computed tomography severity index and an artificial intelligence model, the early achievable severity index prediction score. Moreover, the risk prediction score could distinguish patients into low-risk and high-risk groups according to the best cutoff point. The cutoff point can help doctors in making medical decisions.

Research conclusions

This risk prediction score have potential usefulness in predicting the presence of SAP at an early stage. It could be of great value in guiding clinical decisions as a convenient and specific tool and optimizing the use of medical resources by supporting appropriate treatment.

Research perspectives

To the best of our knowledge, this is the first study attempting to develop a risk prediction score for HTG-induced pancreatitis. But, this was a single-center study with a small sample size, which lacked multi-center data verification. The next step is to conduct a multicenter prospective cohort study with a large sample size to construct specific risk score and externally validate the risk score prior to clinical use.