Clinical features of acute pancreatitis in pregnancy and risk factor analysis for fetal death / 中华胰腺病杂志

ABSTRACT

Objective:To explore the clinical features of acute pancreatitis in pregnancy (APIP) and the risk factors for fetal death.Methods:The clinical data of 90 patients with APIP in the Affiliated Hospital of Southwest Medical University were retrospectively analyzed from January 2013 to June 2020. Based on the severity, the patients were classified into MAP groups ( n=41), MSAP groups ( n=33), SAP group ( n=16). According to the presence of fetal deaths, the patients were divided into fetal death group ( n=13) and fetal survival group ( n=77). The clinical characteristics and indicators of patients in each group were compared. Binary logistic regression analysis was performed on the variables with differences between groups to explore independent risk factors for fetal death. The receiver operating characteristic curves of laboratory indicators were drawn to evaluate their diagnostic efficacy. Results:Hyperlipidemia was the main cause in 90 APIP cases (42/90, 46.7%). The levels of LDH, CRP, blood glucose, D2 polymer, albumin and ApoA1, the 1-min and 5-min Apgar scores of neonates were statistically significant among MAP group, MSAP group and SAP group (all P<0.05). There were no maternal deaths in 90 cases and 13 fetal deaths (14.4%). Fetal mortality increased with the severity of APIP. APIP combined with hypertension ( OR=14.742, 95% CI 1.157-187.890, P=0.038), ketoacidosis ( OR=19.587, 95% CI 1.789-214.469, P=0.015) and CRP level ( OR=1.013, 95% CI 1.001-1.025, P=0.031) were risk factors for fetal death. ApoA1 level ( OR=0.118, 95% CI 0.021-0.664, P=0.015) was a protective factor for fetal death. The sensitivity and specificity of ApoA1 for predicting fetal death were 84.6% and 79.2%, the sensitivity and specificity of CRP for predicting fetal death were 76.9% and 84.4%, and the sensitivity and specificity of the combination of the two indicators for predicting fetal death were 100% and 67.5%. Conclusions:The severity of APIP was closely related to fetal death. Hypertension, ketoacidosis and blood level CRP were independent risk factors for fetal death, which should be paid special attention.