BISAP-O y APACHE-O: utilidad en la predicción de severidad en la pancreatitis aguda según la clasificación modificada de Atlanta / BISAP-O y APACHE-O: utility in predicting severity in acute pancreatitis in modified Atlanta classification

Objetivo: Valorar los puntajes BISAP y APACHE II en predecir severidad según la clasificación Atlanta 2012 y determinar si el factor obesidad añadido a dichos puntajes mejora su predicción. Material y métodos: Se realizó un estudio prospectivo entre enero de 2013 y abril de 2014 de todos los pacientes con pancreatitis aguda según la nueva clasificación Atlanta 2012. Se confeccionó curvas ROC para los puntajes BISAP, BISAP-O, APACHE-II y APACHE-O y se seleccionó puntos de corte apropiados con los que se calculó la sensibilidad, especificidad, VPP, VPN, RPP y la RPN. Resultados: Se estudió a 334 pacientes. El 65,27% presentó sobrepeso u obesidad. La etiología fue biliar en el 86,53%. Sólo 8,38% presentó pancreatitis severa y 1,5% falleció. Las áreas bajo la curva ROC y puntos de corte seleccionados fueron: BISAP: 0,8725, 2; BISAP-O: 0,8246, 3; APACHE-II: 0,8547, 5; APACHE-O: 0,8531, 6. Con dichos puntos de corte la sensibilidad, especificidad, VPP, VPN, RPP y la RPN fueron: BISAP: 60,71%, 91,83%, 40,48%, 96,23%, 7,43, 0,43; BISAP-O: 60,71%, 86,93%, 29,82%, 96,03%, 4,76, 0,45; APACHE-II: 85,71%, 76,14%, 24,74%, 98,31%, 3,6, 0,19; APACHE-O: 82,14%, 79,41%, 26,74%, 97,98%, 4, 0,22. Conclusiones: Los sistemas BISAP, BISAP-O, APACHE-II, y APACHE-O pueden usarse para identificar a los pacientes con bajo riesgo de severidad en razón de su alto VPN, sin embargo su uso debe ser prudente considerando que la RPP y RPN no alcanza niveles óptimos, indicando que su valor en la predicción de severidad es limitado. Por otro lado el añadir el factor obesidad no mejoró su capacidad predictiva.

Objective: To assess the BISAP and APACHE II scores in predicting severity according to the 2012 Atlanta classification and whether the obesity factor added to these scores improves prediction. Material and methods: A prospective study between January 2013 and April 2014 including all patients with acute pancreatitis was performed according to the new Atlanta 2012 classification. ROC curves were fabricated for BISAP, BISAP-O, APACHE-II scores and Apache O and appropriate cutoffs were selected to the sensitivity, specificity, PPV, NPV, RPP and RPN. Results: We studied 334 patients. 65.27% were overweighted or obese. The biliar etiology was 86.53%. Only 8.38% had severe pancreatitis and 1.5% died. Areas under the ROC curve and cut points selected were: BISAP: 0.8725, 2; BISAP-O: 0.8246, 3; APACHE-II: 0.8547, 5; APACHE-O: 0.8531, 6. Using these cutoffs the sensitivity, specificity, PPV, NPV, RPP and RPN were BISAP: 60.71%, 91.83%, 40.48%, 96.23 %, 7.43, 0.43; BISAP-O: 60.71%, 86.93%, 29.82%, 96.03%, 4.76, 0.45; APACHE-II: 85.71%, 76.14%, 24.74%, 98.31%, 3.6, 0.19; APACHE-O: 82.14%, 79.41%, 26.74%, 97.98%, 4, 0.22. Conclusions: BISAP, BISAP-O, APACHE-II and APACHE-O systems can be used to identify patients at low risk of severity because of its high NPV, however their use should be cautious considering that the RPP and RPN do not reach optimal levels indicating that their value in predicting severity is limited. On the other hand adding the obesity factor did not improve their predictive ability.

[Relationship of dietary intake and metabolic factors in chronic spinal cord injury [2010-2011]]

Studies have shown that patients with Spinal Cord Injury [SCI] are susceptible to various diseases including dislipidemia and Cardiovascular Disease [CVD]. In this study for the first time, we evaluated the relationship between dietary intake and metabolic variables of 162 patients. This cross sectional study was done in Tehran University of Medical Sciences. All of the consumed food items and the variables were measured. Independent-sample t-test was used for comparison of dietary intake and serum profile. Multiple regression analysis was used to estimate predicting variables of serum variables. Men as compared to women had higher triglycerides [TG] levels and lower HDL-C levels [p<0.05]. Patients with paraplegia compared to those with tetraplegia had significantly higher total cholesterol and LDL-C levels [p<0.001]. In regard to serum profile, there is a positive correlation between LDL-C levels and age [p<0.05]. Dietary intake of saturated fat showed positive correlation with FBS [p<0.05]. Moreover, there is a significant negative correlation between LDL-C levels and dietary intake of PUFA [p<0.05]. Body Mass Intake [BMI], cholesterol intake and level of trauma were positive predictors for serum cholesterol. Waist circumference, level of injury and cholesterol intake were positive predictors for serum LDL. Moreover, PUFA intake and education level were negative predictor for serum LDL. Despite low intake of saturated fat and cholesterol in older participants, serum LDL level was high. Male group had higher levels of TG. So, attention to dietary intake of patients with SCI and encouraging healthy dietary habits may have important effects on their health