The Role Of Emergency Severity Index (ESI) In Early Recognition,Risk Stratification And Prognosis Evaluation Of Patients With Acute Pancreatitis

Objective:Through the analysis of relevant clinical data,explore the role of Emergency Severity Index（ESI）in early identification,risk stratification and prognosis assessment of patients with acute pancreatitis.Methods:The patients with acute pancreatitis who were admitted to the emergency department of the First Affiliated Hospital of China Medical University from June 2019to June 2020 were taken as the research objects.The relevant materials of the patients were collected,including general information such as age and gender,white blood cells after admission,The percentage of neutrophils,hematocrit,platelets,blood creatinine,calcium ion concentration,procalcitonin,D-dimer,Serum Amylase,Serum Lipase,blood sugarand other laboratory data,imaging（CT）results,BISAP,EPIC and other scores and Prognostic results and so on.The patients were grouped according to the different grades of the Emergency Severity Index（ESI）,the relationship between relevant laboratory indicators and ESI was analyzed,and the ability of ESI to recognize the severity of acute pancreatitis in patients was verified,and ESI was used to assess the different prognosis of patients（ARDS,MODS,Shock,Death,etc.）.Results:A total of 370 patients with acute pancreatitis meeting the criteria were included in this study,including 225 males（60.8%）,145 females（39.2%）,average age（47.67±15.57）years,and 292 non-severe acute pancreatitis（including MAP and MSAP）,78 cases（21.1%）of severe acute pancreatitis（SAP）,including 16 cases（4.3%）in the ESI I group,146 cases（39.5%）in the ESI II group,and 199 cases（53.8%）in the ESI III group,9 cases（2.4%）in the ESI IV group.Through single factor analysis,there is no difference in the age,white blood cell,hematocrit,platelet,calcium ion concentration,D-dimer,serum amylase,serum lipase,blood sugar and other indicators of patients between the different grades of ESI.Statistical significance（all P<0.05）,but there was no significant difference between the groups Thepercentage of Neutrophils（82.68±8.27%VS85.50±5.79%VS 82.04±10.13%VS 78.67±9.98%,P=0.01）,Blood Creatinine（121.62±98.56umol/L VS 102.57±88.63umol/L VS 67.08±48.26umol/L VS 77.22±53.24umol/L,P<0.01）,Procalcitonin（14.23±27.65ng/ml VS 5.27±13.21ng/ml VS 1.53±3.75ng/ml VS1.57±3.10 ng/ml,P<0.01）,BISAP score（2.50±0.73 VS 1.92±0.83 VS 0.99±0.77 VS1.00±0.71,P<0.01）,and EPIC score（4.69±1.01 VS 4.04±1.33 VS 2.98±1.22 VS2.00±1.32,P<0.01）,the difference between each value is statistically significant（all P<0.05）,but blood creatinine was not statistically significant when compared between groups（P>0.05）.Through Spearman rank correlation analysis,it can be found that there is a correlation between BISAP score,EPIC score and ESI classification（rs=-0.525,P=0.000;rs=-0.434,P=0.000）.The^χ2test results indicate that there is a good correlation between the ESI classification and the risk of acute pancreatitis(^χ2=79.66,P<0.01),and it is useful to assess whether the patient is accompanied by pleural and ascites(^χ2=37.14,P<0.01)and the patient’s condition changes from mild to mild.The severe case(^χ2=11.47,P=0.09)is also statistically significant.The ESI classification is relevant for assessing whether a patient has ARDS(^χ2=36.92,P<0.01),MODS(^χ2=11.00,P=0.004),shock(^χ2=7.35,P<0.025)and death(^χ2=15.21,P<0.01)（all P<0.05）.The ESI classification has a better ability to predict the occurrence of ARDS and MODS in patients with acute pancreatitis（AUC=0.75,P<0.01,sensitivity is 84%,specificity is 61%,Youden index is 0.444;AUC=0.75,P<0.01,sensitivity It is 91.7%,specificity is 57.8%,Youden index is 0.495）,but the ability to predict shock in patients with acute pancreatitis is average（AUC=0.69,P<0.05,sensitivity is 80%,specificity is 57.2%,Youden The index is 0.372）,and the ESI classification cannot well predict the death of patients with acute pancreatitis（AUC=0.6,P>0.05,sensitivity is 40%,specificity is 96.2%,Youden index is 0.362）.Conclusions:ESI is of great value in guiding the early diagnosis and treatment of patients with acute pancreatitis.It can accurately identify the severity of AP patients and has high value in predicting the occurrence of ARDS and MODS in AP patients.ESI classification can be applied to the diagnosis and treatment of patients with acute pancreatitis.Early identification,risk stratification and prognosis assessment.