Early Prediction Of Exacerbation Trends In Patients With Acute Pancreatitis By Building A Risk Model

Objective: Based on the related prognostic factors of patients with acute pancreatitis(AP),a risk model for early prediction of the progression of acute pancreatitis was established,and a nomogram was drawn to predict the risk of disease progression.Methods: A total of 90 patients with acute pancreatitis who were hospitalized in our hospital from October 2019 to September 2020 were included.According to the Chinese guidelines for the diagnosis and treatment of acute pancreatitis(Shenyang,2019),the patients were divided into MAP group and SAP group(Moderate Severe Acute Pancreatitis(MSAP)+ Severe Acute Pancreatitis(SAP)).The clinical data of the patients were collected,and the correlation between the levels of serum Tumor Necrosis Factor-α(TNF-α),Interleukin-1(IL-1),Interleukin-6(IL-6),Interleukin-8(IL-8),Interleukin-10(IL-10)and D-lactic acid(D-LA)within 24 hours of admission and the progression of the disease was analyzed.Through univariate analysis,multivariate Lasso regression analysis and multivariate Logistic regression analysis,the risk prediction model of AP severe severity was finally established,and the predictive performance of the model was verified.Results:(1)The results of univariate analysis indicated that there were significant differences in TNF-α,IL-1,IL-6,IL-8,IL-10 and D-LA between the MAP group and the SAP group(P<0.05).And the ROC curve result was TNF-α(AUC=0.781),IL-1(AUC=0.761),IL-6(AUC=0.775),IL-8(AUC=0.823),IL-10(AUC=0.727)and D-LA(AUC)=0.710),suggesting that the above inflammatory mediators and D-LA have good value in predicting the risk of acute pancreatitis exacerbation in the early stage of AP.(2)The results of multivariate Lasso regression indicated that TNF-α,IL-8 and IL-10 were relatively independent predictors of acute pancreatitis severity.(3)Multivariate logistic regression analysis was performed,and a prediction model was constructed based on the multivariate logistic regression results.The C-index and AUC of the model were both 0.866,indicating that the model had a good degree of discrimination.Through AUC comparison,it is suggested that the predictive performance of the model is better than that of single factor and commonly used scoring systems(APACHEII score,Ranson score and BISAP score).Conclusions:(1)IL-1,IL-6 and D-LA are important predictors of early acute pancreatitis severity,and TNF-α,IL-8 and IL-10 are independent predictors of acute pancreatitis severity;(2)The model can predict the severity and severity of acute pancreatitis early and quickly to a certain extent.