Clinical Utility Of The Pancreatitis Activity Scoring System In Severe Acute Pancreatitis

Purpose:To analyze clinical utility of pancreatitis activity rating system(PASS)in prediction of persistent organ failure,poor prognosis,and in-hospital mortality in patients with moderate severe acute pancreatitis(MSAP)or severe acute pancreatitis(SAP)admitted to the intensive care unit(ICU).Methods:140 patients with MSAP and SAP admitted to the ICU of Shandong Provincial Hospital from 2015 to 2021 were included.The general information,biochemical indexes and PASS scores of patients at ICU admission time were collected.Independent risk factors of persistent organ failure,poor prognosis and in-hospital mortality were analyzed by binary logistic regression.Through receiver operating characteristic curve(ROC),the predictive ability of lactic acid,procalcitonin,urea nitrogen,PASS,and PASS in combination with urea nitrogen for the three outcomes was compared.The best cut-off value was determined.At the same time,the ROC curve was also used to compare the predictive ability of PASS score and Ranson score for the three outcomes.Results:1.Binary Logistic regression showed PASS(OR:1.027,95%CI:1.014-1.039),age(OR:1.060,95%CI:1.011-1.111),gender(OR:0.190,95%CI:0.049-0.735)and mean platelet volume(OR:1.851,95%CI:1.133-3.026)were independent risk factors for POF.PASS(OR:1.008,95%CI:1.001-1.014)and lactic acid(OR:1.611,95%CI:1.090-2.380)were independent risk factors for poor prognosis.PASS score(OR:1.009,95%CI:1.000-1.019)was a risk factor for in-hospital death.2.The prediction ability of PASS for persistent organ failure(AUC=0.839,95%CI:0.7699-0.910)and in-hospital death(AUC=0.780,95%CI:0.6699-0.891)was better than that of lactic acid,procalcitonin and urea nitrogen.3.Urea nitrogen combined with PASS was associated with persistent organ failure(AUC=0.849,95%CI:0.779--0.920),poor prognosis(AUC=0.801,95%CI:0.726-0.876),and in-hospital death(AUC=0.796,95%CI:0.697-0.894)were better than any single index.4.The prediction ability of PASS for persistent organ failure(AUC=0.839,95%CI:0.769 to 0.910),poor prognosis(AUC=0.756,95%CI:0.675 to 0.837)and in-hospital death(AUC=0.780,95%CI:0.669--0.891)was better than Ranson score.Conclusions:1.PASS scores,age,gender and mean platelet volume are independent risk factors for persistent organ failure in patients with MSAP and SAP.2.PASS score and lactic acid are independent risk factors for poor prognosis in MSAP and SAP patients.3.The ability of PASS score to predict POF and in-hospital death in MSAP and SAP patients was stronger than that of lactic acid,procalcitonin and urea nitrogen.The predictive ability of urea nitrogen combined PASS score was greater than that of any single index.4.PASS score is significantly better than Ranson score in predicting the occurrence of POF,poor prognosis,and in-hospital death of MSAP and SAP,and may be widely used in clinic as a major score.