Predictive value of the ratio of bedside index of severity in acute pancreatitis to serum calcium in the degree of severity in acute pancreatitis
10.3760/cma.j.cn311367-20230830-00058
- VernacularTitle:急性胰腺炎严重程度床边指数与血清钙比值对急性胰腺炎严重程度的预测价值
- Author:
Ziqin FENG
1
;
Weichang CHEN
Author Information
1. 苏州大学附属第一医院消化内科，苏州 215006
- Keywords:
Acute pancreatitis;
Severity;
Bedside index of severity in acute pancreatitis;
Serum calcium;
Respiratory dysfunction
- From:
Chinese Journal of Digestion
2023;43(12):800-805
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the predictive value of the ratio of bedside index of severity in acute pancreatitis (BISAP) to serum calcium (BISAP/Ca) within 24 hours of admission in the severity of acute pancreatitis (AP).Methods:From January 1, 2020, to December 31, 2022, 711 AP patients visited the First Affiliated Hospital of Soochow University were enrolled. According to the severity of AP, the 711 patients were divided into mild AP group (586 cases) and severe AP group (including moderately severe and severe AP patients, 125 cases). According to the occurrence of respiratory dysfunction, the 711 patients were divided into a group without respiratory dysfunction (594 cases) and a group with respiratory dysfunction (117 cases). Acute physiology and chronic health evaluation-Ⅱ (APACHE-Ⅱ) score was calculated based on the worst indicators (highest or lowest values) within 24 hours of admission. BISAP score was calculated based on the indicator values of the patients within 24 hours of admission. And modified computed tomography (CT) severity index (MCTSI) score was calculated based on the results of enhanced CT within 72 hours of admission. Mann-Whitney U test and chi-square test were used for statistical comparison. The predictive value of BISAP/Ca for the severity of AP was assessed by receiver operating characteristic curve (ROC), and the optimal cut-off value was calculated based on sensitivity and specificity. Univariate and multivariate logistic regression analyses were used to analyze the risk factors of developing respiratory dysfunction in AP patients. Results:The hospital stay, proportion of patients with systemic inflammatory response syndrome, proportion of patients with pleural effusion, and scores of APACHE-II, BISAP, MCTSI, and BISAP/Ca of the severe AP group were higher than those of the mild AP group (18.00 d (12.00 d, 29.00 d) vs. 9.00 d (6.00 d, 12.00 d), 74.4% (93/125) vs. 22.5% (132/586), 90.4% (113/125) vs. 42.3% (248/586), 9.00(6.00, 13.50) vs. 4.00(2.00, 7.00), 2.00(2.00, 3.00) vs. 1.00(0.00, 1.00), 4.00(4.00, 6.00) vs. 4.00(2.00, 4.00), 1.05(0.92, 1.54) vs. 0.47(0.00, 0.55)), all the differences were statistically significant ( Z=-12.39, χ2=128.16 and 95.28, Z=-10.83, -12.50, -11.54, and -13.27; all P<0.001). The results of ROC analysis showed that the area under the curve (95% confidence interval) of BISAP/Ca, BISAP, serum calcium, MCTSI, and APACHE-Ⅱ score for predicting the severity of AP were 0.873 (0.842 to 0.904), 0.839 (0.804 to 0.875), 0.797 (0.752 to 0.843), 0.802 (0.762 to 0.842), and 0.807 (0.762 to 0.852), respectively, all the differences were statistically significant (all P<0.001). According to the Youden index, the optimal cut-off value of BISAP/Ca distinguishing mild AP from severe AP was 0.515, with a sensitivity of 0.880 and a specificity of 0.722. The result of multivariate logistic regression analyses showed that BISAP/Ca >0.515 was an independent risk factor of developing respiratory dysfunction in AP ( OR (95% confidence interval) 27.588(14.083 to 54.045), 12.057 (5.762 to 25.229), both P<0.001). Conclusion:BISAP/Ca may be a valuable predictive indicator for the severity and developing respiratory dysfunction in AP patients.
