| Objective:The prognosis of severe acute pancreatitis remains far from good,and early risk assessment plays an important role in reducing the fatality rate and optimizing treatment of patients with severe acute pancreatitis.The purpose of this study was to explore the early risk factors affecting the prognosis of patients with severe acute pancreatitis,so as to take timely clinical intervention measures to avoid the occurrence of poor prognosis.Methods:Patients with severe acute pancreatitis admitted to the Department of Hepatobiliary Surgery,Affiliated Hospital to Guizhou Medical University from September 2018 to September 2021 were retrospectively analyzed,and their general data,laboratory indicators,organ failure and clinical outcomes were collected.The patients were divided into death group and survival group according to the clinical outcome,and the clinical characteristics of the clinical data were compared between the groups.To further explore the related high-risk factors that affect the prognosis of severe acute pancreatitis.Results:A total of 161 SAP patients were included,including 97 males(60.2%)and 64females(39.8%),with a mean age of 52.8 years,and 15 deaths.The overall mortality rate was 9.32%(15/161).The etiologies were: biliary pancreatitis in 85 cases(52.8%),hyperlipidemia pancreatitis in 31 cases(19.3%),other 27 cases(16.8%),and alcoholic pancreatitis in 18 cases(11.2%).Univariate analysis showed that blood urea nitrogen(BUN),serum creatinine(Cr),serum albumin(ALB),prothrombin time(PT),and procalcitonin(PCT)were statistically significant(P<0.05).Logistic regression analysis showed that blood urea nitrogen(BUN),serum albumin(ALB),and procalcitonin(PCT)were risk factors for early death in patients with severe acute pancreatitis.The ROC curve analysis showed that the area under curve(AUC)of BUN,ALB and PCT were 0.820,0.790,0.797(P<0.05),respectively,the sensitivity was 65.80%,74.00%,59.60%,the specificity was were 86.70%,80.00%,and 93.30%,and the best cut-off values were6.30mmol/L,34.05g/L,and 2.42ng/m L,respectively.The AUC,sensitivity and specificity of the three combined were 0.914,84.9% and 86.7%,respectively.Subgroup analysis showed that: 1.When BUN≥7.47mmol/L,the risk of death was 5.3times that of BUN<3.4mmol/L;2.When ALB≤32.90g/L,the risk of death was 10 times that of ALB>42.40g/L;3.When PCT≥5.57ng/m L,the risk of death is 9.5 times that of PCT<0.57ng/m L.The BISAP score and APACHE-II score of the death group were higher than those of the survival group.ROC curve analysis showed that the BISAP score was better than the APACHE-II score in predicting the death of severe acute pancreatitis,and the AUCs were 0.845vs0.757,respectively.The sensitivity and specificity were 86.70% vs 66.7% and 63.00% vs 71.9%,respectively.Analysis of organ function and complications showed that renal failure,circulatory failure and septic shock were the risk factors of death in patients with severe acute pancreatitis.Conclusions:1.BUN≥6.30mmol/L,ALB≤34.05g/L and PCT≥2.42ng/m L can early predict the death risk of SAP patients,and the combination of the three has a good predictive value for the SAP death risk;2.The risk of death was significantly increased when BUN≥7.47mmol/L,ALB≤32.90g/L and PCT≥5.57 ng/m L;3.BISAP score is more valuable than APACHE-II score in predicting SAP death risk.4.Renal failure,circulatory failure and septic shock were most correlated with death in SAP patients. |
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