Risk Factors Analysis And Risk Assessment Model Establishment Of AP Severity

Objective:1.To analyze the risk factors of severity of AP and establish a risk assessment model of severity of AP.2.To analyze the clinical features and risk factors of obese patients with AP.Methods:1.305 patients with AP within 72 hours of onset,with complete basic information and examination results within 24 hours of admission,hospitalizing in Department of Gastroenterology,Shanghai Sixth People’s Hospital from January 2014 to March 2018,were selected,including 261 patients in non-SAP group(MAP+MSAP)and 44 patients in SAP group.By comparing the results of various research indicators obtained within 24 hours of admission between non-SAP group and SAP group,the independent risk factors of SAP were obtained and the risk assessment model of AP severity was established after logistic regression analysis.The risk assessment model was evaluated by the area under curve(AUC)and calibration.The optimal boundary value of the risk assessment model determined by the Youden index.2.The above-mentioned 305 AP patients with incomplete BMI were excluded(28 cases),and the remaining 277 AP patients were divided into two groups,non-obese group(BMI<28 kg/m2)(224 cases)and obese group(BMI>28 kg/m2)(53 cases).Comparing non-obese group and obese group,logistic regression analysis was used to obtain independent risk factors for obese patients with AP.RESULTS:1.The independent risk factors of SAP were BMI,HR,absolute value of neutrophils,and protective factors of SAP were chloride ion,phosphorus ion and PaO2.The risk assessment model of AP severity was established as follows:A=4.025+0.115 x BMI+0.05 x HR+0.164 x absolute value of neutrophils-0.068 x chlorine-3.205 x phosphorus-0.089 x PaO2(unit of absolute value of neutrophils:x10^9/L).The model has good discrimination and calibration.When A is greater than or equal to 0.076,SAP is considered.When A is less than 0.076,non-SAP is considered.The sensitivity and specificity are 95.5%and 73.6%respectively.2.Logistic regression analysis found that a history of hyperlipidemia and a history of fatty liver are both independent risk factors for obese patients with AP.CONCLUSION:1.BMI,HR and neutrophil absolute value were independent risk factors for SAP,while chloride ion,phosphorus ion and PaO2 were protective factors for SAP.2.The risk assessment model of AP severity established can accurately distinguish SAP from non-SAP,so that SAP patients can be screened early and treated actively.3.A history of hyperlipidemia and a history of fatty liver disease are independent risk factors for obese patients with AP.