Analysis Of Death Risk Factors Of Severe Acute Pancreatitis And Establishment Of Risk Assessment Model

Background:Severe Acute Pancreatitis,(SAP)is a common critical illness,which has an acute onset,dangerous condition,difficult treatment and long period,and seriously threatens human life and health[1].In recent years,the incidence of SAP has gradually increased,and the cost of treatment and medical resources are huge,and there is still a lack of specific and effective treatment methods.Although the comprehensive treatment system of diagnosis,treatment,monitoring and nursing for patients with severe acute pancreatitis is constantly updated and developed,the mortality rate of SAP is extremely high,even reaching 20%-40%in China[2].Therefore,it is of great significance to predict the severity of SAP disease according to the actual situation of patients,realize the best clinical decision for patients,improve the prognosis of SAP patients and reduce the mortality rate of SAP patients.With the in-depth study of the pathogenesis of SAP,it is found that one of the main pathological mechanisms of SAP is the serious imbalance between the levels of pro-inflammatory cytokines and anti-inflammatory factors caused by excessive abnormal activation of polymorphonuclear leukocytes(PMN),which leads to systemic inflammatory response syndrome and finally causes serious damage to the body[3,4].As the only Neutrophil elastase(NE)inhibitor qualified for marketing and applied in clinic at present,sivelestat sodium can inhibit the abnormal activation of PMN mainly composed of neutrophils,so it may have an important application prospect in alleviating the progress of SAP diseases[5].Studies have pointed out that sivelestat sodium has certain therapeutic value in the treatment of SAP in animal experiments[6,7],but there is no clinical research support at present.In this study,the risk factors of death of SAP patients were found by retrospective analysis,the prognostic analysis model was constructed,and the value of sivelestat sodium in the treatment of SAP patients was analyzed,which further provided reference for clinical diagnosis and treatment of SAP[8].Research scheme:1.In the study,88 patients with SAP who were treated in the Department of Critical Care Medicine of The Second Affiliated Hospital of Dalian Medical University from September 1,2017 to September 1,2022 were selected as the research object,and the information of patients was retrieved through the medical record information retrieval system of The Second Affiliated Hospital of Dalian Medical University,and the clinical data of patients in the included group were collected according to the diagnostic criteria of SAP(consensus of experts on acute pancreatitis in 2021),and the patients were divided into death group(51 cases)and survival group(37 cases).The clinical data of the two groups were analyzed by univariate analysis,and the factors with significant statistical significance were analyzed by unconditional logistic multivariate regression combined with the actual clinical significance,and the risk factors of SAP death were analyzed and the risk assessment model of severe acute pancreatitis was constructed.2.When looking for the risk factors of SAP death,we found that the application of sivelestat sodium can significantly reduce the mortality rate of patients,which is statistically significant in univariate analysis and multivariate analysis.Therefore,we further divided 88 patients into two groups:those who received sivelestat sodium(17 cases)and those who did not receive sivelestat sodium(71 cases)for statistical analysis,and observed whether there were blood purification time,mechanical ventilation time,hospitalization time and survival rate in the two groups.Research results:1.There were significant statistical differences between the two groups in APACHE Ⅱ score,Modified Marshall score,SOFA score,urea nitrogen,intra-abdominal pressure level,blood amylase,early start-up of enteral nutrition,blood lipase,negative balance of liquid plan,sivelestat sodium,hospital stay and ICU stay(P<0.05).Combined with the actual clinical significance,multivariate Logistic regression analysis found that the Modified Marshall score[OR=1.651,95%CI:(1.105～2.466)]and the Modified CT score[OR=1.884,95%CI:(1.210～2.932)]were the risk factors for the death of SAP patients,and early enteral nutrition[95%CI:(0.010～0.712)],negative balance of liquid plan[OR=0.125,95%CI:(0.020～0.767)],application of sivelestat sodium[or = 0.043,95%CI:(0.002～0.999)The regression equation is as follows:Logistic(P)=(-3.224)+0.633× Modified CT score+0.501 ×Modified Marshall score-2.459×early enteral nutrition-2.077× negative balance of liquid plan-3.151 × sivelestat sodium.It is verified that the risk assessment model has high accuracy and strong accuracy.2.The survival rate of SAP patients who applied sivelestat sodium was higher.In all regression analysis models,sivelestat sodium showed good statistical significance and was an independent protective factor of SAP,but it did not significantly reduce the mechanical ventilation time,hemofiltration treatment time and hospitalization time of SAP patients.Conclusion:Modified CT score and Modified Marshall score are the risk factors for the death of SAP patients,and early enteral nutrition,negative balance of liquid plan and sivelestat are the protective factors for SAP patients,which can reduce the death rate of SAP,and the established SAP prognosis model can effectively carry out risk assessment.