| ObjectivesResearch on the relation of laboratory indexes,obesity-related imaging indexes and the comorbidities of acute pancreatitis to the severity of acute pancreatitis.A prediction model was constructed to predict moderate severe and severe acute pancreatitis early and efficiently,so as to determine whether referral should be made and the formulation of early treatment plans.MethodsThe clinical data of 192 acute pancreatitis patients admitted to the First Affiliated Hospital of Fujian Medical University from January 2016 to June 2019 were retrospectively collected and analyzed.According to Classification of acute pancreatitis—2012:revision of the Atlanta classification and definitions by international consensus[1],192 patients were divided into mild acute pancreatitis group（n=120）and moderate severe and severe acute pancreatitis group（n=72）,while the grouping criteria were whether there was organ failure and its duration and whether it was combined with local or systemic complications.The clinical data（age,gender,etiology,comorbidities,BISAP,laboratory indexes,and obesity-related imaging indexes）available within 24hours after admission were compared between the two groups.The independent risk factors of moderate severe and severe acute pancreatitis were determined by univariate and multivariate analysis,and the independent risk factors of moderate severe and severe acute pancreatitis were incorporated into the model based on BISAP.The area under the ROC curve（AUC）was used to evaluate the efficacy of the model and BISAP in predicting moderate severe and severe acute pancreatitis.The AUC of the model and BISAP in predicting moderate and severe acute pancreatitis are compared by the Z test.ResultsThe clinical characteristics of 192 acute pancreatitis patients were analyzed.According to the severity of acute pancreatitis,the majority of the acute pancreatitis patients in this study were mild acute pancreatitis（62.5%）.According to etiological analysis,biliary pancreatitis accounted for 56.8%,which means the biliary tract disease was the most common cause of acute pancreatitis.There were no statistically significant differences in gender,age,etiology,diabetes mellitus,biliary tract disease,cardiovascular disease,chronic kidney disease,cirrhosis,and chronic pulmonary disease between the mild and moderate severe and severe groups（P>0.05）.The difference between the two groups was statistically significant in hypertension and cerebrovascular disease（P<0.05）,the proportion of moderate severe and severe patients with hypertension and cerebrovascular diseases was higher than that of mild patients.The differences of BISAP,white blood cell（WBC）,neutrophil to lymphocyte ratio（NLR）,platelet to lymphocyte ratio（PLR）,lymphocyte to monocyte ratio（LMR）,systemic immune inflammation index（SII）,serum calcium（Ca）,albumin（ALB）,aspartate aminotransferase（AST）,total bilirubin（TBIL）,direct bilirubin（DBIL）,lactate dehydrogenase（LDH）,triglyceride（TG）,visceral adipose tissue（VAT）and visceral adipose tissue to skeletal muscle ratio（VMR）between the two groups was statistically significant（P<0.05）.After univariate analysis,BISAP,WBC,NLR,PLR,LMR,SII,Ca,ALB,AST,TBIL,LDH,VAT,VMR,combined with hypertension,combined with cerebrovascular disease were found to be risk factors for moderate severe and severe acute pancreatitis.Multivariate analysis showed that BISAP,NLR,LDH and VMR were independent risk factors for moderate severe and severe acute pancreatitis.BISAP,NLR,LDH and VMR were incorporated into the equation to establish a binary logistic regression equation:-6.116+0.479x BISAP+0.17x NLR+0.004x LDH+1.535x VMR.The AUC was 0.907,higher than that of BISAP（0.760）,and the difference was statistically significant（P<0.05）.Conclusions1.In this study,the majority of AP cases are mild（62.5%）.The most common cause is biliary disease（56.8%）.2.VMR,LDH,NLR and BISAP are independent risk factors for moderate severe and severe acute pancreatitis.3.The model based on BISAP,incorporating independent risk factors（VMR,LDH,NLR）is better than BISAP in predicting moderate severe and severe acute pancreatitis. |
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