ABSTRACT
Objective:To investigate the predictive value of acute gastrointestinal injury (AGI) score for the severity of acute pancreatitis (AP), infectious pancreatic necrosis and patients′ death.Methods:Clinical data of 719 patients with AP were collected from the AP database of the National Clinical Research Center for Digestive System Diseases from January 2016 to June 2018. According to the severity of the disease, they were divided into MAP group (506 cases), MSAP group (112 cases) and SAP group (101 cases). AGI, APACHEⅡ, MCTSI and BISAP scores were calcululated in the three groups. Receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated. The predictive value of the above four scoring systems for the hospitalization days, disease severity, infectious pancreatic necrosis and death was analyzed, respectively.Results:There were no cases of infectious pancreatic necrosis or death in the MAP group, but there were 9 cases of infectious pancreatic necrosis and 2 deaths in the MSAP group and 19 cases of infectious pancreatic necrosis and 8 deaths in the SAP group. There was a strong correlation between AGI score and AP patients′ hospitalization days ( r=0.619). AUC of AGI, APACHEⅡ, MCTSI and BISAP score in predicting the AP patients′ severity (MSAP+ SAP) was 0.967 (95% CI 0.951-0.982), 0.769(95% CI 0.720-0.899), 0.842(95% CI 0.809-0.875), 0.862 (95% CI0.832-0.893). AUC for forecasting infectious pancreatic necrosis was 0.803, 0.677, 0.692, 0.724, and the 95% CI was 0.724-0.882, 0.573-0.781, 0.582-0.636, 0.801-0.812. AUC for predicting death in patients with AP were 0.915, 0.597, 0.659, 0.812, and the 95% CI were 0.843-0.986, 0.444-0.751, 0.498-0.698 and 0.882-0.926. AGI score had the highest predictive value, followed by BISAP score, and the correlation between these two scores was the closest. The predictive value of AGI combined with BISAP score for infectious pancreatic necrosis and patient death (AUC were 0.837, 0.942, 95% CI were 0.770-0.903, 0.897-0.987) was better than that of AGI and BISAP score alone. Conclusions:AGI score combined with BISAP score is more effective in predicting the severity of AP, the occurrence of infectious pancreatic necrosis or patient death.
ABSTRACT
Objective@#To explore the predictive value of acute gastrointestinal injury(AGI) grading system in assessing the severity, infectious pancreatic necrosis and death of patients with moderate severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP).@*Methods@#The clinical data of 344 patients with MSAP or SAP admitted in Changhai Hospital Affiliated to Navy Medical University from June 2011 to June 2015 were collected. ROC curve was used and the area under ROC curve (AUC) was calculated. The predictive value of AGI grade for the severity, infectous pancreatic necrosis and death was compared with those of different clinical scores(APACHEⅡ score, MCTSI and Marshal score).@*Results@#Of 344 patients, 81 patients were classified into high AGI grade group (Grade Ⅲ, Ⅳ), while 263 patients were in low AGI grade group(Grade Ⅰ, Ⅱ). The mortality and the number of patients with organ failure were obviously higher in high AGI grade group than those in low AGI grade group (25/81 vs 0/263, 36/45 vs 32/231), and the difference was statistically significant (all P<values 0.001). AUC of high AGI grade for predicting patients′ death and infectious pancreatic necrosis was 0.944(95% CI 0.916-0.972) and0.779(95% CI 0.723-0.836), respectively, which was higher than those of APACHEⅡ and Marshall score.@*Conclusions@#AGI grading system can be applied to better assess the severity of acute pancreatitis, and its predictive value for death and infectious pancreatic necrosis was higher than that of APACHEⅡ, MCTSI and Marshall score.
ABSTRACT
Objective To explore the predictive value of acute gastrointestinal injury( AGI) grading system in assessing the severity, infectious pancreatic necrosis and death of patients with moderate severe acute pancreatitis ( MSAP) and severe acute pancreatitis ( SAP) . Methods The clinical data of 344 patients with MSAP or SAP admitted in Changhai Hospital Affiliated to Navy Medical University from June 2011 to June 2015 were collected. ROC curve was used and the area under ROC curve ( AUC) was calculated. The predictive value of AGI grade for the severity, infectous pancreatic necrosis and death was compared with those of different clinical scores(APACHEⅡ score, MCTSI and Marshal score). Results Of 344 patients, 81 patients were classified into high AGI grade group ( Grade Ⅲ,Ⅳ) , while 263 patients were in low AGI grade group( GradeⅠ,Ⅱ) . The mortality and the number of patients with organ failure were obviously higher in high AGI grade group than those in low AGI grade group (25/81 vs 0/263,36/45 vs 32/231), and the difference was statistically significant (all P<values 0.001). AUC of high AGI grade for predicting patients' death and infectious pancreatic necrosis was 0.944(95％ CI 0.916-0.972) and 0.779(95％ CI 0.723-0.836), respectively, which was higher than those of APACHEⅡ and Marshall score. Conclusions AGI grading system can be applied to better assess the severity of acute pancreatitis, and its predictive value for death and infectious pancreatic necrosis was higher than that of APACHEⅡ, MCTSI and Marshall score.