Development and external validation of models to predict acute respiratory distress syndrome related to severe acute pancreatitis

doi:10.3748/wjg.v28.i19.2123

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World Journal of Gastroenterology

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Retrospective Cohort Study

World J Gastroenterol. May 21, 2022; 28(19): 2123-2136
Published online May 21, 2022. doi: 10.3748/wjg.v28.i19.2123

Table 1 Characteristics of non-severe acute pancreatitis and severe acute pancreatitis patients in derivation and validation cohort

Characteristic	Derivation cohort		P value	Validation cohort		P value
Characteristic	non-SAP (n = 327)	SAP (n = 80)	P value	non-SAP (n = 131)	SAP (n = 59)	P value
Age (yr)	49.0 (36.0; 63.5)	46.0 (34.8; 62.2)	0.424	40.0 (32.0; 58.5)	44.0 (38.0; 53.0)	0.371
Female (%)	131 (40.1)	27 (33.8)	0.363	63 (48.1)	14 (23.7)	0.003
Weekend admission (%)	65 (19.9)	26 (32.5)	0.023	37 (28.2)	13 (22.0)	0.471
Etiology (%)			0.021			0.003
Biliary	113 (34.6)	31 (38.8)		54 (41.2)	11 (18.6)
Hypertriglyceridemia	113 (34.6)	36 (45.0)		44 (33.6)	21 (35.6)
Alcoholic	27 (8.26)	7 (8.75)		5 (3.82)	8 (13.6)
Others	74 (22.6)	6 (7.50)		28 (21.4)	19 (32.2)
Peritoneal irritation (%)	74 (22.6)	31 (38.8)	0.005	27 (20.6)	32 (54.2)	< 0.001
GCS < 15 (%)	2 (0.61)	5 (6.25)	0.004	3 (2.29)	7 (11.9)	0.011
Tem (℃)	36.6 (36.4; 37.0)	37.2 (36.5; 38.2)	< 0.001	37.0 (36.8; 37.4)	38.0 (37.5; 38.4)	< 0.001
SBP (KPa)	17.2 (15.9; 18.7)	16.4 (14.9; 18.8)	0.119	16.3 (15.2; 18.4)	16.8 (14.7; 19.5)	0.949
HR (bpm)	82.0 (76.0; 94.5)	118 (99.5; 132)	< 0.001	89.0 (79.0; 102)	110 (100; 130)	< 0.001
RR (bpm)	20.0 (18.0; 20.0)	22.0 (20.0; 28.2)	< 0.001	20.0 (18.0; 21.0)	23.0 (20.5; 29.5)	< 0.001
WBC (× 10⁹/L)	11.6 (8.74; 15.2)	14.2 (10.2; 18.7)	0.001	12.4 (8.70; 15.6)	16.4 (12.2; 21.1)	< 0.001
HCT (%)	40.8 (37.5; 44.8)	43.6 (36.9; 48.4)	0.022	41.3 (37.8; 45.0)	42.9 (36.5; 49.0)	0.218
PLT (×10⁹/L)	221 (178; 276)	192 (156; 274)	0.03	232 (196; 278)	202 (166; 264)	0.025
K (mmol/L)	3.90 (3.60; 4.25)	3.90 (3.50; 4.30)	0.817	3.90 (3.50; 4.10)	4.00 (3.50; 4.55)	0.074
Na (mmol/L)	137 (134; 140)	137 (132; 140)	0.909	137 (133; 140)	137 (133; 140)	0.664
Ca (mmol/L)	2.26 (2.13; 2.34)	1.96 (1.74; 2.16)	< 0.001	2.22 (2.08; 2.32)	1.93 (1.77; 2.10)	< 0.001
Cr (μmol/L)	67.0 (55.0; 80.0)	90.0 (70.8; 142)	< 0.001	61.0 (52.0; 77.0)	90.0 (62.5; 227)	< 0.001
BUN (mmol/L)	5.00 (3.88; 6.34)	7.06 (5.26; 10.4)	< 0.001	4.66 (3.32; 5.84)	6.67 (4.91; 14.2)	< 0.001
Glu (mmol/L)	8.00 (6.50; 12.9)	11.0 (7.45; 16.3)	< 0.001	8.70 (6.80; 11.8)	11.3 (8.05; 17.2)	0.004
Local complication (%)	104 (31.8)	73 (91.2)	< 0.001	66 (50.4)	55 (93.2)	< 0.001
ICU admission (%)	12 (3.67)	37 (46.2)	< 0.001	12 (9.16)	38 (64.4)	< 0.001
ICU stays (d)	0.00 (0.00; 0.00)	0.00 (0.00; 10.0)	< 0.001	0.00 (0.00; 0.00)	5.00 (0.00; 9.00)	< 0.001
Hospital stays (d)	10.0 (7.00; 14.0)	17.5 (8.75; 25.0)	< 0.001	9.00 (4.00; 15.0)	23.0 (15.0; 30.0)	< 0.001
Mortality (%)	0 (0.00)	3 (3.75)	0.007	1 (0.76)	4 (6.78)	0.033
qSOFA	0.00 (0.00; 0.00)	1.00 (0.00; 1.00)	< 0.001	0.00 (0.00; 1.00)	1.00 (0.00; 1.00)	< 0.001
SIRS	1.00 (0.00; 2.00)	3.00 (2.00; 3.00)	< 0.001	1.00 (0.00; 2.00)	3.00 (2.00; 3.00)	< 0.001
BISAP	1.00 (0.00; 1.00)	2.00 (2.00; 3.00)	< 0.001	1.00 (0.00; 2.00)	2.00 (2.00; 3.00)	< 0.001

SAP: Severe acute pancreatitis; GCS: Glasgow coma score; Tem: Temperature; SBP: Systolic blood pressure; HR: Heart rate; RR: Respiratory rate; WBC: White blood cell; HCT: Hematocrit; PLT: Platelet; Cr: Creatine; BUN: Blood urea nitrogen; Glu: Glucose; ICU: Intensive care unit; qSOFA: Quick sequential organ failure assessment; SIRS: Systemic inflammatory response syndrome; BISAP: Bedside index for severity in acute pancreatitis.

Table 2 Characteristics of non-acute respiratory distress syndrome and acute respiratory distress syndrome patients in derivation and validation cohorts

Characteristic	Derivation cohort		P value	Validation cohort		P value
Characteristic	non-ARDS (n = 345)	ARDS (n = 62)	P value	non-ARDS (n = 153)	ARDS (n = 37)	P value
Age (yr)	49.0 (36.0; 64.0)	42.0 (33.2; 59.5)	0.062	40.0 (33.0; 57.0)	48.0 (41.0; 57.0)	0.082
Female (%)	138 (40.0)	20 (32.3)	0.312	67 (43.8)	10 (27.0)	0.093
Weekend admission (%)	73 (21.2)	18 (29.0)	0.228	39 (25.5)	11 (29.7)	0.751
Etiology (%)			0.024			0.187
Biliary	122 (35.4)	22 (35.5)		56 (36.6)	9 (24.3)
Hypertriglyceridemia	119 (34.5)	30 (48.4)		53 (34.6)	12 (32.4)
Alcoholic	28 (8.12)	6 (9.68)		8 (5.23)	5 (13.5)
Others	76 (22.0)	4 (6.45)		36 (23.5)	11 (29.7)
Peritoneal irritation (%)	80 (23.2)	25 (40.3)	0.007	39 (25.5)	20 (54.1)	0.002
GCS < 15 (%)	4 (1.16)	3 (4.84)	0.075	4 (2.61)	6 (16.2)	0.004
Tem (℃)	36.6 (36.4; 37.0)	37.5 (36.5; 38.2)	< 0.001	37.0 (36.8; 37.5)	38.0 (37.8; 38.5)	< 0.001
SBP (mmHg)	129 (119; 140)	123 (110; 141)	0.113	123 (116; 140)	119 (106; 147)	0.192
HR (bpm)	82.0 (76.0; 96.0)	120 (103; 134)	< 0.001	90.0 (80.0; 110)	115 (100; 140)	< 0.001
RR (bpm)	20.0 (18.0; 20.0)	23.0 (20.0; 30.0)	< 0.001	20.0 (18.0; 22.0)	24.0 (20.0; 29.0)	< 0.001
WBC (× 10⁹/L)	11.9 (8.76; 15.3)	13.9 (9.91; 19.5)	0.006	12.5 (9.07; 16.3)	17.6 (13.6; 22.8)	< 0.001
HCT (%)	40.8 (37.5; 44.8)	45.2 (38.3; 48.7)	0.002	41.3 (37.4; 45.2)	43.9 (38.0; 49.4)	0.094
PLT (× 10⁹/L)	218 (176; 275)	207 (167; 274)	0.26	228 (192; 278)	208 (168; 261)	0.112
K (mmol/L)	3.90 (3.60; 4.30)	3.90 (3.50; 4.20)	0.441	3.90 (3.50; 4.20)	3.90 (3.50; 4.40)	0.429
Na (mmol/L)	137 (134; 140)	137 (132; 140)	0.95	137 (133; 140)	139 (132; 144)	0.038
Ca (mmol/L)	2.25 (2.12; 2.34)	1.88 (1.65; 2.12)	< 0.001	2.16 (2.01; 2.29)	1.96 (1.77; 2.22)	0.002
Cr (μmol/L)	67.0 (55.0; 81.0)	86.5 (72.0; 134)	< 0.001	62.0 (53.0; 79.0)	96.0 (65.0; 230)	< 0.001
BUN (mmol/L)	5.03 (3.90; 6.44)	7.28 (5.25; 10.3)	< 0.001	4.80 (3.37; 6.48)	6.97 (5.37; 14.4)	< 0.001
Glu (mmol/L)	8.10 (6.50; 13.1)	11.0 (7.67; 16.1)	< 0.001	8.80 (6.90; 13.6)	11.3 (8.10; 16.8)	0.032
Local complication (%)	115 (33.3)	62 (100)	< 0.001	88 (57.5)	33 (89.2)	0.001
Ventilator (%)	3 (0.87)	4 (6.45)	0.012	0 (0.00)	23 (62.2)	< 0.001
ICU admission (%)	16 (4.64)	33 (53.2)	< 0.001	21 (13.7)	29 (78.4)	< 0.001
ICU stays (d)	0.00 (0.00; 0.00)	2.50 (0.00; 11.8)	< 0.001	0.00 (0.00; 0.00)	7.00 (1.00; 11.0)	< 0.001
Hospital stays (d)	10.0 (7.00; 15.0)	19.0 (11.0; 25.0)	< 0.001	10.0 (4.00; 19.0)	23.0 (15.0; 30.0)	< 0.001
Mortality (%)	1 (0.29)	2 (3.23)	0.062	1 (0.65)	4 (10.8)	0.005

ARDS: Acute respiratory distress syndrome; GCS: Glasgow coma score; Tem: Temperature; SBP: Systolic blood pressure; HR: Heart rate; RR: Respiratory rate; WBC: White blood cell; HCT: Hematocrit; PLT: Platelet; Cr: Creatine; BUN: Blood urea nitrogen; Glu: Glucose; ICU: Intensive care unit; qSOFA: Quick sequential organ failure assessment; SIRS: Systemic inflammatory response syndrome; BISAP: Bedside index for severity in acute pancreatitis.

Table 3 Multivariable logistic regression analysis for severe acute pancreatitis and acute respiratory distress syndrome prediction in derivation cohort

Variable	SAP			ARDS
Variable	β	OR (95% CI)	P value	β	OR (95% CI)	P value
Intercept	-6.42	0.00 (0.00-0.05)	< 0.001	-5.46	0.00 (0.00-0.13)	0.002
HR	0.05	1.05 (1.04-1.07)	< 0.001	0.05	1.05 (1.03-1.07)	< 0.001
RR	0.08	1.08 (1.00-1.17)	0.047	0.10	1.10 (1.02-1.19)	0.014
Ca	-1.30	0.26 (0.09-0.73)	0.011	-1.78	0.17 (0.06-0.48)	0.001
BUN	0.14	1.15 (1.09-1.23)	< 0.001	0.11	1.12 (1.05-1.19)	< 0.001

SAP: Severe acute pancreatitis; ARDS: Acute respiratory distress syndrome; OR: Odds ratio; HR: Heart rate; RR: Respiratory rate; Ca: Serum calcium concentration; BUN: Blood urea nitrogen.

Table 4 Sensitivity, specificity, positive predictive value, negative predictive value for of the predictive models in combined cohort

SAP						ARDS
PA	SE	SP	Youden index	PPV	NPV	PA	SE	SP	Youden index	PPV	NPV
> 10%	0.91	0.63	0.54	0.43	0.96	> 5%	0.94	0.48	0.42	0.26	0.98
> 20%	0.82	0.83	0.65	0.59	0.94	> 10%	0.85	0.71	0.56	0.37	0.96
> 25%	0.78	0.88	0.66	0.66	0.93	> 18%	0.78	0.85	0.63	0.51	0.95
> 40%	0.71	0.93	0.64	0.75	0.91	> 30%	0.67	0.93	0.59	0.65	0.93
> 60%	0.51	0.97	0.48	0.84	0.87	> 50%	0.46	0.96	0.43	0.71	0.90
> 80%	0.32	0.99	0.30	0.88	0.83	> 70%	0.29	0.98	0.27	0.71	0.87
> 95%	0.14	1.00	0.14	0.91	0.79	> 85%	0.12	1.00	0.12	0.86	0.85

PA: Probability; SE: Sensitivity; SP: Specificity; PPV: Positive predictive value; NPV: Negative predictive value.

Citation: Li YL, Zhang DD, Xiong YY, Wang RF, Gao XM, Gong H, Zheng SC, Wu D. Development and external validation of models to predict acute respiratory distress syndrome related to severe acute pancreatitis. World J Gastroenterol 2022; 28(19): 2123-2136
URL: https://www.wjgnet.com/1007-9327/full/v28/i19/2123.htm
DOI: https://dx.doi.org/10.3748/wjg.v28.i19.2123