A New Scoring System With Multiple Biomarkers To Predict Persistent Organ Failure In Acute Pancreatitis

Aims: AP(acute pancreatitis)is an inflammatory disorder characterized by local and systemic immuno-inflammation,which is observed clinically as a spectrum ranging from local pancreatitis to systemic inflammatory response,organ failure(OF)and death.According to 2012 revised Atlanta classification for AP,severe AP has been redefined as AP with persistent OF(OF lasts more than 48 h).We have found a serious of biomarkers that independently associated with POF in AP.The aim of our study is to conduct a scoring system to predict POF.Materials and methods: We retrospectively reviewed data of AP patients from January 2009 to December 2017.To find out the most sensitive biomarker of each organ system,admission demographic parameters and laboratory data of one group(1679 patients)were collected and compared between patients with and without POF.Multivariable logistic regression analyses were utilized to evaluate the independent prognostic factor.After that,one scoring system is built and tested in another group of AP patients(1223 ones).Results: Using small amount of patient data,we found that RDW(red cell distribution width),NLR(neutrophil to lymphocyte ratio),MPV(mean platelet volume)and serum albumin are best presentative of organ systems such as circulating,immune,thrombosis and hepatology in predicting POF in AP.Then we combine them with biomarkers such as creatinine(renal system),Pa O2/Fi O2(respiratory system),serum calcium and LDH(lactate dehydrogenase),to form a new scoring system.Each biomarker is defined 0 or 1 according to the cut-off values.Then the predictive ability is tested in 12223 patients.We found that if one patient scores more than 4,the ability to predict POF is appreciative.The sensitivity is 94.8% and specificity 86.2%,with an area under the curve(AUC)of 0.967.Conclusion: By utilizing multiple factors that reflecting different organ systems,we conducted a new scoring system to predict POF in patients with AP.More prospective researches are asking to further clarify our findings.