Development and validation of a risk prediction score for the severity of acute hypertriglyceridemic pancreatitis in Chinese patients

doi:10.3748/wjg.v28.i33.4846

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World Journal of Gastroenterology

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World J Gastroenterol. Sep 7, 2022; 28(33): 4846-4860
Published online Sep 7, 2022. doi: 10.3748/wjg.v28.i33.4846

Table 1 Demographic and clinical characteristics of patients in the non-severe acute pancreatitis and severe acute pancreatitis groups

Patient characteristics	All (n = 243)	Non-SAP (n = 181)	SAP (n = 62)	P value
Demographic variables
Sex, n (%)				0.297
Male	188 (77.37)	143 (79.00)	45 (72.60)
Female	55 (22.63)	38 (21.00)	17 (27.40)
Age (yr)	40.12 ± 10.12	39.60 ± 10.10	41.60 ± 10.20	0.190
BMI (kg/m²)	28.27 ± 4.25	28.10 ± 4.00	28.70 ± 4.90	0.367
Medical history
Diabetes, n (%)				0.648
Yes	139 (57.20)	102 (56.40)	37 (59.70)
No	104 (42.80)	79 (43.65)	25 (40.30)
Hypertension, n (%)				0.164
Yes	59 (24.28)	48 (26.50)	11 (17.70)
No	184 (75.72)	133 (73.50)	51 (82.30)
Hyperlipidemia, n (%)				0.250
Yes	152 (62.55)	64 (35.40)	27 (43.50)
No	91 (37.45)	64 (35.40)	27 (43.50)
Fatty liver, n (%)				0.073
Yes	185 (76.13)	143 (79.00)	42 (67.70)
No	58 (23.87)	38 (21.00)	20 (32.30)
Drinking, n (%)				0.483
Yes	120 (49.38)	87 (48.10)	33 (53.20)
No	123 (50.62)	94 (51.90)	29 (46.80)
Smoking, n (%)				0.386
Yes	133 (54.73)	102 (56.40)	31 (50.00)
No	110 (45.27)	79 (43.60)	31 (50.00)
Clinical signs
HR (bpm)	96.14 ± 18.17	92.23 ± 16.30	107.58 ± 18.65	< 0.001
R (bpm)	21.66 ± 5.33	20.47 ± 4.38	25.27 ± 6.21	< 0.001
SBP (mmHg)	133.50 ± 17.52	133.51 ± 16.56	133.48 ± 20.21	0.992
DBP (mmHg)	81.13 ± 12.03	80.85 ± 11.28	81.92 ± 14.08	0.548
		Non-SAP (n = 181, 74.49%)	SAP (n = 62, 25.51%)
Laboratory findings
WBC (× 10⁹/L)	12.53 ± 3.86	11.96 ± 3.63	14.41 ± 3.97	< 0.001
NLR	9.94 ± 7.27	8.82 ± 6.98	13.19 ± 7.15	< 0.001
RDW (fL)	12.87 ± 0.72	12.80 ± 0.69	13.08 ± 0.78	0.009
PLT (× 10⁹/L)	218.91 ± 61.98	216.09 ± 57.99	227.15 ± 72.30	0.226
MPV (fL)	10.75 ± 1.05	10.68 ± 1.01	10.95 ± 1.14	0.074
PDW (fL)	12.66 ± 2.22	12.47 ± 2.09	13.23 ± 2.47	0.018
TC (mmol/L)	10.15 ± 4.11	9.54 ± 3.62	11.94 ± 4.92	< 0.001
TG (mmol/L)	21.08 ± 7.50	20.17 ± 7.31	23.75 ± 7.49	0.001
H/L ratio	0.96 ± 1.36	0.96 ± 1.36	0.97 ± 1.36	0.946
ApoA1 (g/L)	1.02 ± 0.35	1.11 ± 0.34	0.75 ± 0.23	< 0.001
TBIL (μmol/L)	14.16 ± 8.29	13.81 ± 7.11	15.16 ± 11.03	0.987
AST (U/L)	29.78 ± 17.41	27.40 ± 13.03	36.76 ± 25.20	< 0.001
ALT (U/L)	31.04 ± 28.70	30.80 ± 29.94	31.73 ± 24.94	0.826
ALP (U/L)	73.91 ± 25.30	73.59 ± 22.70	74.84 ± 31.88	0.737
ALB (g/L)	41.57 ± 5.91	42.22 ± 5.53	39.66 ± 6.58	0.003
BUN mmol/L	4.32 ± 2.03	4.05 ± 1.39	5.10 ± 3.12	< 0.001
Cr (μmol/L)	62.62 ± 42.98	56.64 ± 15.83	80.10 ± 78.56	< 0.001
fT3 (pmol/L)	1.97 ± 0.37	1.99 ± 0.36	1.91 ± 0.41	0.134
CRP (mg/L)	160.20 ± 127.36	133.55 ± 112.64	237.99 ± 136.59	< 0.001
PCT (ng/mL)	0.80 ± 1.93	0.59 ± 1.72	1.42 ± 2.35	0.003
ESR (mm/h)	42.57 ± 24.76	40.71 ± 25.10	47.99 ± 23.06	0.045
Na (mmol/L)	133.97 ± 4.29	134.28 ± 4.09	133.07 ± 4.76	0.054
K (mmol/L)	4.02 ± 0.46	3.97 ± 0.35	4.19 ± 0.67	0.080
Ca²⁺(mmol/L)	2.13 ± 0.26	2.19 ± 0.18	1.96 ± 0.36	< 0.001
PT (s)	13.26 ± 0.98	13.12 ± 0.84	13.68 ± 1.21	< 0.001
APTT (s)	37.82 ± 5.28	37.35 ± 5.14	39.22 ± 5.45	0.016
TT (s)	15.07 ± 1.10	15.08 ± 1.09	15.05 ± 1.13	0.823
FIB (g/L)	5.70 ± 2.21	5.41 ± 2.10	6.56 ± 2.32	< 0.001
D-dimer (μg/L)	1.34 ± 1.83	0.94 ± 0.98	2.51 ± 2.94	< 0.001
Imaging results
Pleural effusion, n (%)				< 0.001
Yes	69 (28.40)	23 (12.71)	46 (74.19)
No	174 (71.61)	158 (87.30)	16 (25.81)

BMI: Body mass index; RR: Respiratory rate; HR: Heart rate; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; SAP: Severe acute pancreatitis; Non-SAP: Mild acute pancreatitis and moderately sever acute pancreatitis; WBC: White blood cell; NLR: Neutrophil to lymphocyte ratio; RDW: Red blood cell distribution width; PLT: Platelet counts; RDW: MPV Mean platelet volume; PDW: Platelet distribution width; TC: Total cholesterol; TG: Triglyceride; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; ApoA1: Apolipoprotein A1; TBIL: Total bilirubin; AST: Aspartate transaminase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; ALB: Albumin; BUN: Blood urea nitrogen; Cr: Creatinine; fT3: Free triiodothyronine; CRP: C-reactive protein; PCT: Procalcitonin; Na: Sodium; K: Potassium; Ca²⁺: Calcium; PT: Prothrombin time; APTT: Activated partial thromboplastin time; TT: Thrombin time; FIB: Fibrinogen; SAP: Severe acute pancreatitis; Non-SAP: Mild acute pancreatitis and moderately sever acute pancreatitis.

Table 2 Univariable and multivariable logistic regression analyses of predictive factors for severe acute pancreatitis in all subjects

Variables	Univariable regression		Multivariable regression
Variables	OR (95%CI)	P value	OR (95%CI)	P value
Age	1.02 (0.99-1.05)	0.190	1.07 (1.01-1.14)	0.033
BMI (kg/m²)	1.03 (0.96-1.10)	0.366	1.08 (0.94-1.24)	0.278
Hypertension
No	1.00		1.00
Yes	0.60 (0.29-1.24)	0.167	1.02 (0.99-1.06)	0.201
Diabetes
No	1.00		1.00
Yes	1.15 (0.64-2.06)	0.648	1.27 (0.38-4.24)	0.693
HR (bpm)	1.05 (1.03-1.07)	< 0.0001	1.02 (0.99-1.06)	0.201
RR (bpm)	1.20 (1.12-1.28)	< 0.0001	1.12 (0.99-1.26)	0.068
TG (mmol/L)
< 11.3	1.00		1.00
11.3-22.6	2.06 (0.57-7.49)	0.273	4.20 (0.40-44.25)	0.232
≥ 22.6	3.43 (0.96-12.20)	0.057	5.95 (0.56-62.75)	0.138
ApoA1 (g/L)	0.01 (0.00-0.05)	< 0.0001	0.02 (0.00-0.12)	< 0.0001
Cr (μmol/L)	1.02 (1.01-1.03)	0.002	1.01 (0.99-1.02)	0.458
Bun (μmol/L)	1.27 (1.10-1.48)	0.001	1.29 (0.92-1.81)	0.145
WBC (× 10⁹/L)	1.18 (1.09-1.28)	< 0.0001	1.08 (0.95-1.24)	0.248
Ca²⁺ (mmol/L)	0.02 (0.01-0.09)	< 0.0001	0.11 (0.01-1.02)	0.040
D-dimer (μg/L)	1.69 (1.35-2.12)	< 0.0001	1.24 (0.94-1.63)	0.122
Pleural effusion	19.75 (9.64-40.48)	< 0.0001	15.62 (5.05-48.24)	< 0.0001

BMI: Body mass index; RR: Respiratory rate; HR: Heart rate; SBP: Systolic blood pressure; WBC: White blood cell; ApoA1: Apolipoprotein A1; BUN: Blood urea nitrogen; Cr: Creatinine; Ca: Calcium; SAP: Severe acute pancreatitis; OR: Odds ratio.

Table 3 Comparison of diagnostic performance for predicting severe acute pancreatitis between the AAP and other existing clinical scores

Variables	ΔAUC	95%CI	Z statistic	P value
AAP-APACHE II	0.122	0.057-0.187	3.661	0.000
AAP-BISAP	0.076	0.007-0.198	3.839	0.000
AAP-MCTSI	0.098	0.027-0.305	3.111	0.002
AAP-Ranson	0.104	0.048-0.159	3.670	0.000
AAP-EASY	0.122	0.056-0.188	3.606	0.000

AAP: Our risk prediction score referred to as AAP; EASY: EASY prediction score; ΔAUC: Difference of areas under curve between AAP and other clinical scores; SE: Standard error; CI: Confidence interval; SAP: Severe acute pancreatitis.

Table 4 Diagnostic performance of the integrated discrimination improvement between the AAP and other clinical scores

Variables	IDI	SE	95%CI	Z statistic	P value
AAP-APACHE-II	0.201	0.077	0.050-0.352	2.601	0.009
AAP-BISAP	0.095	0.052	0.037-0.115	1.828	0.068
AAP-MCTSI	0.166	0.071	0.036-0.160	2.339	0.019
AAP-Ranson	0.216	0.063	0.093-0.338	3.444	0.001
AAP-EASY	0.205	0.082	0.045-0.365	2.513	0.012

IDI: Integrated discrimination improvement; SE: Standard error; CI: Confidence interval; AAP: Our risk prediction score referred to as AAP; EASY: EASY prediction score; SAP: Severe acute pancreatitis.

Table 5 The relationship between risk stratification and clinical parameters

	Low-risk group (n = 158)		High-risk group (n = 85)	P value
Local complications
APFC	43 (27.22%)	68 (80.00%)		< 0.001
PPC	3 (1.90%)	10 (11.77%)		0.001
ANC	3 (1.90%)	22 (25.88%)		< 0.001
WON	0 (0.00%)	4 (4.71%)		0.014
Systemic complications
SIRS	92 (58.23%)	72 (84.71%)		< 0.001
Respiratory failure	29 (18.35%)	59 (69.41%)		< 0.001
Renal failure	0 (0.00%)	13 (15.29%)		< 0.001
Cardiovascular failure	2 (1.27%)	5 (5.88%)		0.040
Clinical Scoring Systems
Ranson ≥ 3	28 (17.72%)	53 (62.35%)		< 0.001
BISAP ≥ 3	0 (0.00%)	4 (4.71%)		0.014
MCTSI ≥ 4	15 (9.49%)	53 (62.35%)		< 0.001
APACHE-II ≥ 8	73 (46.20%)	68 (80.00%)		< 0.001
CRP ≥ 190	42 (26.58%)	44 (51.77%)		< 0.001
Hospital day, days	13.51 ± 5.45	20.04 ± 8.14		< 0.001

APFC: Acute peripancreatic fluid collection; PPC: Pancreatic pseudocyst; ANC: Acute necrotic collection; WON: Walled-off necrosis; IPN: Infected pancreatic necrosis; SIRS: Systemic inflammatory response syndrome.

Citation: Liu ZY, Tian L, Sun XY, Liu ZS, Hao LJ, Shen WW, Gao YQ, Zhai HH. Development and validation of a risk prediction score for the severity of acute hypertriglyceridemic pancreatitis in Chinese patients. World J Gastroenterol 2022; 28(33): 4846-4860
URL: https://www.wjgnet.com/1007-9327/full/v28/i33/4846.htm
DOI: https://dx.doi.org/10.3748/wjg.v28.i33.4846