The Value Of High-Density Lipoprotein Cholesterol,Blood Urea Nitrogen, And Serum Creatinine For The Prediction Of Severe Acute Pancreatitis

Part I High-Density Lipoprotein Cholesterol,Blood Urea Nitrogen,and Serum Creatinine Can Predict Severe Acute Pancreatitis.Aims: The aim of the study was to develop a model able to predict Severe Acute Pancreatitis(SAP)and,at the same time,to assess both Serum Creatinine(Scr)and blood urea nitrogen(BUN)at 24 hours after admission and High-Density Lipoprotein Cholesterol(HDL-C)as predictors of SAP.Methods: The following informations were collected for each patient: age,gender,Body Mass Index(BMI),etiology,hematocrit,High-Density Lipoprotein Cholesterol(HDL-C)at admission.BUN and Serum creatinine(Scr)were registered at the time of admission and 24?hrs after hospitalization.The data were assessed by a univariate and a multivariate logistic regression analysis.The area under the receiver operating characteristic curve(AUC)was used to evaluate the performance of predictions.Internal validation was performed by bootstrap technique.Results: Univariate analysis suggested that BMI,etiology,hematocrit,HDL-C at admisson,BUN and Scr at the time of admission and 24?hours after hospitalization were significantly associated with severe acute pancreatitis.Multivariate logistic regression indicated that HDL-C at admission,BUN and Scr at 24?hours(hrs)were independently associated to SAP.A logistic regression function(LR model)was developed to predict SAP as follows:-2.25-0.06 HDL-C(mg/dl)at admission +0.06 BUN(mg/dl)at 24 hours +0.66 Scr(mg/dl)at 24?hours.Based on bootstrap validation analysis,the optimism-corrected c-index for LR model was 0.832 after bootstrap validation.Based on the ROC curve analysis,the AUCs for HDL-C at admission,BUN after 24?hrs of admission,Scr after 24?hrs of admission and LR model for the prediction of SAP were 0.76,0.79,0.76 and 0.84,respectively.Conclusions: The LR model consists of HDL-C at admission,BUN and Scr at 24?hours,representing an additional tool to stratify patients at risk of SAP.Part II Blood urea nitrogen as a predictor of severe acute pancreatitis based on the revised Atlanta criteria: timing of measurement and cutoff pointsAims.This study evaluated the prognostic accuracy of BUN for severe acute pancreatitis(SAP)and in-hospital mortality(IHM)in terms of the best timing for BUN measurement and the optimal BUN cutoff points.Methods.BUN determinants at the time of admission and 24?hrs after hospital admission were recorded and analyzed statistically.The following information was collected for each patient: age,gender,Body Mass Index,etiology,white blood cell,hemoglobin,platelet count,and serum electrolytes at admission.BUN and serum creatinine(Scr)were collected at the time of admission and 24?hrs after hospital admission.Univariate Analysis was performed between Patients with or without SAP.Variables in univariate analysis found to be significantly related to SAP were selected as candidates for ROC curve analysis.The ability of BUN in predicting the SAP and the occurrence of IHM were assessed using the area under the receiver-operating characteristic(ROC)curve.Results.Univariate Analysis indicated that hemoglobin at admission,platelets at admission,white blood cell,calcium,BUN at admission,BUN 24?hrs after hospital admission,Scr at admission,and Scr after 24?hrs of hospital admission were significantly associated with the severity of AP.For SAP,AUC of BUN at admission and 24?hrs after hospital admission was 0.75 and 0.80,respectively.For IHM in acute pancreatitis,it was 0.86 at admission and 0.84 after 24?hrs of hospital admission,respectively.The optimal cutoff point of BUN 24?hrs after hospital admission for SAP and at admission for IHM was 8.3?mmol/L and 13.3?mmol/L,respectively.Conclusion.BUN determination after 24?hrs of hospital admission has high accuracy for prediction of SAP while BUN at initial admission has high accuracy for prediction of IHM.BUN is an useful prognostic predictor of AP.Part III Predictors of acute pancreatitis with low elevation of serum amylaseAims: Serum amylase is a traditional measure,used to establish the diagnosis of acute pancreas(AP).However,it may remain within the normal range on admission in as many as one-fifth of patients The current study aimed to assess predictors and clinical outcome of AP with low serum amylase.Methods: All patients were divided into two groups,based on their serum amylase level within the first two days after hospital admission: group 1(amylase?300 U/L)and group 2(amylase<300 U/L).Clinical outcomes were compared between the two groups before and after 1:1 propensity score matching.Clinical and biochemical parameters were collected and evaluated as potential predictors of AP with low serum amylase.Results: A total of 464 patients were enrolled.After propensity score matching according to age,gender,time interval before admission,hematocrit,blood urea nitrogen(BUN),and creatinine,108 matched pairs of patients were selected.There was no significant statistical difference between group 2 and group 1 with respect to severity of AP,median of days of stay in hospital and death.Multivariate analysis indicated that biliary etiology(OR:0.499;95% CI:0.265-0.942;P=0.003),low-density lipoprotein cholesterol(LDL-C)(OR:1.009;95% CI:1.002-1.017;P=0.017)and triglyceride(OR:1.001;95% CI:1.0001-1.001;P=0.015)were independently associated with development of AP along with low serum amylase.There was no statistical relationship between High-density lipoprotein cholesterol(HDL-C)and AP along with low serum amylase(OR: 0.998;95%CI:0.9898-1.0064;P = 0.646).Conclusions: Serum amylase level was not related to the severity of AP,median hospital days and death.Biliary etiology,LDL-C and triglyceride were independently associated with the development of AP with lower elevation of serum amylase.