AMulti-center Study Of BISAPin Judging Severity And Prognosis Of Acute Pancreatitis

Part One AMulti-center Study of BISAPin Judging Severity andPrognosis ofAcute PancreatitisObjective To evaluate the value of bedside index for severity in acute pancreatitis(BISAP) in judging the severity and prognosis of acute pancreatitis(AP).Methods411patients of AP admitted into seven hospitals in Suzhou fromNovember2011to November2013were studied prospectively. BISAP within24h,APACHE-Ⅱ within24h,Ranson’s within48h and Balthazar CT(CTSI)scores within72h were calculated,the change of condition and prognosis was followed up.The AUC ofROC was used to evaluate the ability of BISAP and APACHE-Ⅱ,Ranson’s,CTSI scoringsystems in judging the severity of AP and the occurrence of pancreatic necrosis,organfailure and mortality．Results411patients included161severe acute pancreatitis (SAP),50cases ofpancreatic necrosis,55cases of organ failure and13deaths.The incidence of pancreaticnecrosis and organ failure,mortality and SAP increased along with BISAP score.The risk ofpancreatic necrosis, organ failure,mortality and SAP in patients with BISAP score≥3wassignificantly higher than that of<3(P <0.001). The AUC of BISAP for SAP was0.929(95%Cl0.906-0.953).When the cut-off value was2,judgment value was similar toRanson’s and APACHE-Ⅱscores,and significantly better than CTSI score. The AUC ofBISAP for pancreatic necrosis was0.860(95%Cl0.810-0.909).When the cut-off valuewas2,judgment value was similar to Ranson’s and APACHE-Ⅱ scores,and significantlyworse than CTSI score.The AUC of BISAP for organ failure was0.916(95%Cl0.882 -0.950).When the cut-off value was3,judgment value was similar to Ranson’s andAPACHE-Ⅱ scores,and significantly better than CTSI score.The AUC of BISAP formortality was0.969(95%Cl0.945-0.993).When the cut-off value was3,judgment valuewas similar to APACHE-Ⅱ,Ranson’s and CTSI scores.Its sensitivity (100%) wassignificantly better than Ranson’s (76.9%), APACHE-Ⅱ (7.7%) and CTSI scores(38.5%).Conclusion As a new and simple scoring system,which provides an important andbetter rule for evaluating the clinical condition of acute pancreatitis． Part Two Clinical Significance of Early Detection of Serum sCD40inPatients withAcute PancreatitisObjective CD40is a co-stimulatory molecule in immune response, and plays anvaluable role in the mediation of immunoregulatory signals via binding to its ligandCD40L. Previous studies revealed that soluble CD40(sCD40) was extraordinarilyup-regulated in peripheral blood and body fluid in various diseased status. To explore theserum level of sCD40in patients with acute pancreatitis (AP) at early stage of admissionand its clinical significance.Methods A total of seventy-two inpatients with AP (44cases of MAP and28casesof SAP) were randomly selected and the serum level of sCD40was measured by ELISAwithin24hours after admission. Twenty-one healthy subjects receiving routine medicalexamination were served as controls. The diagnostic performance of early stage serumsCD40for identifying AP and predicting AP-associated acute lung injury (ALI) wasevaluated by ROC curve.Results Serum sCD40level within24hours after admission was significantlyhigher in AP patients than in healthy controls (P<0.01), and that in SAP was higher thanthat in MAP with no significance. A significant positive correlation was found betweenserum sCD40and serum CRP in AP patients within24hours after admission (r=0.413, P=0.000). Area under the ROC curve (AUC) by serum sCD40for identifying AP was0.806and the cut-off value was≥29.45pg/mL. AUC by serum sCD40for predictingAP-associated ALI was0.808, which was higher than that of APACHEⅡ score(AUC=0.733), Ranson’s score (AUC=0.648) and serum CRP (AUC=0.625); the cut-offvalue was≥47.96pg/mL.Conclusions Detection of serum sCD40at early stage may be beneficial for earlyassessing disease severity and predicting AP-associated ALI.