Early Predictive Value Of BISAP Score Combined With Erythrocyte Distribution Width To Serum Calcium Ion Ratio For The Severity Of Acute Pancreatitis

【Objective】Acute Pancreatitis（AP）is a serious acute inflammatory disease in which the pancreas is digested by the pancreatic enzyme itself.Its prognosis depends mainly on the occurrence of organ failure and secondary pancreatic or peripancreatic necrotic infection,and it is the most common gastrointestinal disease requiring emergency admission in clinical practice.Mild Acute Pancreatitis（MAP）accounts for the majority of cases and is easily recovered through supportive treatment,but Severe Acute Pancreatitis（SAP）is characterized by rapid onset,rapid progression and severe disease,often combined with many complications and a high mortality rate.The key to SAP is early diagnosis,timely assessment of the severity and treatment of complications,and if the disease can be predicted and evaluated at an early stage and the severity of the disease can be accurately judged,the treatment plan can be formulated,the death rate can be reduced,the prognosis can be improved and the economic burden can be reduced.It is of great significance and value.It is of great clinical significance to study and explore the assessment methods for early determination of AP severity.The purpose of this study was to investigate the correlation between the bedside index of severity（BISAP）score of acute pancreatitis,red blood cell distribution width to serum calcium ion ratio(RDW/Ca²⁺)and the severity of AP patients and the predictive value of the BISAP score combined with RDW/Ca²⁺in determining the severity of early disease in patients with acute pancreatitis.【Methods】In this study,464 patients with AP admitted to the First Affiliated Hospital of Dali University from 09,2018 to 08,2020 were retrospectively collected,and the inclusion criteria were divided into three groups:the MAP group,the MSAP group and the SAP group according to the 2012 Atlanta Revised Classification Criteria^[1].After admission,the basic information of each patient,vital signs within 24 h of admission and the laboratory indexes such as routine blood,liver and kidney function,blood calcium,CRP and imaging examinations were collected from peripheral venous blood drawn from patients,and the BISAP score,RDW/Ca²⁺were calculated,respectively,to compare and analyze whether there were any statistical differences between the data of the three groups.The area under the ROC curve（AUC）was calculated based on the results of plotting the subject’s work characteristics（ROC）curve,and the cut-off values were selected according to the best Yordon index,and the sensitivity and specificity corresponding to each cut-off value were calculated separately to assess the diagnostic and predictive values of BISAP score,RDW/Ca²⁺and BISAP score combined with RDW/Ca²⁺on the severity of AP.【Results】1.A total of 464 patients with AP were enrolled in this study,including men:280（60.3%）and 184（39.7%）women,with a mean age of 46.02±13.94 years（14-85years）,281（60.6%）in the MAP group,135（29.1%）in the MSAP group,and 48（10.3%）in the SAP group.According to the etiology:the most common was biliary origin in 215 cases（46.3%）,which was the main etiology for the occurrence of AP,followed by other causes in 114 cases（24.6%）,which was the secondary etiology for the development of AP,with hyperlipidemic 65 cases（14.0%）and alcoholic 70 cases（15.1%）occupying the third and fourth positions,respectively.2.The BISAP score and RDW/Ca²⁺increased sequentially in the MAP group（0.44±0.54,5.92±0.72）,MSAP group（1.67±0.66,6.56±1.30）and SAP group（2.23±0.72,8.31±3.13）in all three groups,with statistically significant differences（P<0.05）.3.By performing Pearson correlation analysis,RDW/Ca²⁺was positively correlated with BISAP score（r=0.366,P<0.001）.4.According to the comparison of the area under the ROC curve（AUC）,the BISAP score combined with RDW/Ca²⁺（AUC=0.923）was more valuable in predicting SAP than both BISAP score（AUC=0.877）and RDW/Ca²⁺（AUC=0.865）alone,and the difference was statistically significant（both P<0.05）.5.The value of the BISAP score combined with RDW/Ca²⁺in predicting the severity of AP was compared with the MCTSI score and CRP in clinical practice.the value of the BISAP score combined with RDW/Ca²⁺（AUC=0.923）in predicting SAP was higher than that of the MCTSI score（AUC=0.736）and CRP（AUC=0.728）both alone,with statistically significant differences（all P<0.05）.【Conclusion】1.As the severity of AP increases,the BISAP score and RDW/Ca²⁺are increasing,both of which have important value and clinical significance in predicting the severity of AP.2.There was a positive correlation between the relationship between RDW/Ca²⁺and BISAP scores.3.The BISAP score at admission combined with RDW/Ca²⁺was better than the BISAP score and RDW/Ca²⁺alone in predicting the severity of AP early in the disease,with better predictive significance and value.4.The value of the BISAP score at admission combined with RDW/Ca2+in predicting the severity of AP disease in the early stage of disease is better than that of MCTSI score and CRP,and has a better clinical application.5.Biliary origin still dominates the etiology of AP development.