Value of strong ion gap for predicting the severity of acute pancreatitis / 中华急诊医学杂志

ABSTRACT

Objective To investigate the value of strong ion gap (SIG) in predicting the severity of acute pancreatitis (AP) based on the revised Atlanta classification. Methods A total of 133 patients with AP admitted from January, 2015 to December, 2016 were enrolled. Of them, there were 55 with mild AP (MAP), 52 with moderately severe AP (MSAP) and 26 with severe AP (SAP). All patients with AP conformed to the diagnostic criteria of Guidelines or Diagnosis and Treatment of Acute Pancreatitis set in 2014 in China. Patients with other underlying diseases that might influence the clinical outcome were excluded, including those with diabetic ketoacidosis, chronic renal failure and other disorders. The changes in blood SIG levels in each group were observed. The correlations between SIG and acute physiology, chronic health evaluation (APACHE) Ⅱ score, Ranson score and length of hospital stay were analyzed. The receiver operating characteristic curves (ROC) were plotted to determine the efficiency of SIG, Scr, APACHE Ⅱ score, and Ranson score for predicting the severity of acute pancreatitis. Results The level of SIG in the SAP group was the highest, followed by the MSAP group and the lowest in the MAP group.There were significant differences in pairwise comparisons (P<0.01). The correlations between SIG and APACHE Ⅱ score (r=0.567, P<0.01), Ranson score (r=0.502, P<0.01), and length of hospital stay were positive (r=0.589, P<0.01). There was no statistical difference in the area under curve (AUC) between SIG and APACHE Ⅱ score (0.874±0.029 vs.0.895±0.025, P>0.05) and as well as Ranson score (0.874±0.029 vs. 0.890±0.027, P>0.05) for predicting moderately-severe acute pancreatitis, but SIG was superior to Scr (0.874±0.029 vs. 0.735±0.043, P<0.01). There was a significant difference in AUC between SIG and Scr (0.910±0.030 vs. 0.755±0.054, P<0.01), but no statistical differences between SIG and APACHE Ⅱ score (0.910±0.030 vs. 0.867±0.034, P>0.05) and Ranson score (0.910±0.030 vs. 0.871±0.032, P>0.05) for predicting severe acute pancreatitis. Conclusion SIG has important clinical significance for predicting the severity of acute pancreatitis.