Related Factors And Pregnancy Outcome Of The Severity Of Acute Pancreatitis In Pregnancy Population

Objective: Acute pancreatitis in pregnancy(APIP)is a serious threat to maternal and fetal health during pregnancy.This study aims to explore the related factors of APIP severity and pregnancy outcome,in order to provide theoretical basis for clinical diagnosis and treatment of APIP.Methods: A total of 113 patients with APIP with complete data admitted to Shengjing Hospital of China Medical University from January 2012 to December 2019 were retrospectively collected.Quantitative data numbers and percentages were presented to analyze etiology in relation to pregnancy duration and APIP severity.Clinical characteristics within 48 hours of the first onset and fasting laboratory examination indexes before treatment were counted.The study used SPSS20.0 statistical software.Single factor analysis test and multiple comparison were applied to the continuous variables with normal distribution.The independent sample Kruskal-Wallis test and multiple comparison were applied to continuous variables with non-normal distribution(P <0.05,the difference is statistical significance).ROC curve was used to analyze each index and the two most representative indicators were selected for ROC curve analysis for combination to predict the value of MSAP and SAP.Single factor analysis of logistic,the significant factors on single factor analysis test were performed in Multivariate Logistic regression analysis(P<0.05,the difference is statistical significance).Fisher Chi-square test was used to analyze the differences between pregnancy outcomes and pregnancy outcome.Results: According to the etiology,the incidence of hyperlipidemia pancreatitis and biliary pancreatitis in pregnant women was 53.1% and 17.7%,among which hyperlipidemia pancreatitis was more likely to develop SAP.APIP is most prevalent in the third trimester of pregnancy,regardless of etiology.According to the Revised Atlanta Classification,there were significant differences in gravidity,C-reactive protein(CRP),fasting blood glucose,creatinine,urea,triglyceride(TG),total cholesterol and?-glutamyltransferase(P<0.05).One group which combined MSAP and SAP cases was compared with MAP group,gravidity,CRP,WCC,Plt,fasting blood glucose,triglyceride and total cholesterol had positive correlation to predict the severity of APIP(P<0.05).Gestational age and low density lipoprotein had negative correlation to predict the severity of APIP(P<0.05).Among the predictors of APIP severity,the highest predictive power is CRP,with a sensitivity and specificity of 64.8% and 80.0%,and a cut-off value of 112mg/L.The sensitivity,specificity and cut-off value of TG were 56.8%,92% and8.255mmol/L respectively.The AUC for combination curve of CRP and TG was 0.783 with a sensitivity of 0.807.There were statistical significance in pregnancy age,parity,CRP,WCC,Plt,triglyceride and total cholesterol(P<0.05).Parity(odds ratio(OR)=4.496,95%CI 1.352 to 14.957)and CRP(OR=1.009,95%CI 1.001 to 1.017)were independent risk factors for MSAP and SAP(P<0.05).Pregnancy outcome,including therapeutic induction of labor(<28 weeks),iatrogenic preterm labor,term labor and intrauterine fetal death,of APIP patients with different severity was not significant.The occurrence of intrauterine fetal death was not associated with the severity of APIP.Conclusion: The most common type of APIP is hyperlipidemia pancreatitis.CRP and TG have a strong ability to predict MSAP and SAP in the early stage.Independent risk factors for MSAP and SAP in APIP patients were multipara and increasing CRP level.There was no difference in pregnancy outcome among APIP patients with different severity.There is no significant difference in the occurrence of fetal death in utero.We should pay attention to the patients with different severity of APIP.