Predictors For Prognosis Of Acute Pancreatitis Obesity, Hepatic Steatosis And Infection

Background and AimPrediction for the prognosis of acute pancreatitis (AP) remains a difficulteissue in the clinical work. Many scoring systems are applied as prognosticmethods, but there are several shortcomings. First, the scoring system, which isgenerally composed by several parameters, is very complex. Second, there is alag for the prediction by using the present scoring systems. Most parametersincluded in the scoring system are altered after the change of clnical condition.Third, a majority of scoring systems can only be applied in the early stage of APand is unavailable during the course of this disease. Therefore, the present studywas proposed to explore two kinds of new predictors: one presents even early inthe clinical course of AP and the other demonstrats during the course of APMethodsThe methods of Meta-analysis, corhort study and case-control study wereadopted. The prognostic efficacy of obesity, overweight, hepatic steatosis andinfection time were evaluated.ResultsOverweight, obesity and hepatic steatosis are risk factors for the poorprognosis of AP. The incidence of SAP (OR3.36,95%CI2.35-4.81), localcomplications (OR6.2395%CI3.90-9.94), systemic complications (OR2.95,95%CI1.85-4.69) and mortality (OR3.3195%CI1.96-5.60) were higher in theobese patients with AP. The incidence of SAP (OR2.48,95%CI1.34–4.60), local complications (OR2.58,95%CI1.20–5.57), and mortality (OR3.81,95%CI1.22–11.83) were higher in the overweight patients with AP. Hepatic steatosisis an independent risk factor for higher incidence of SAP(OR4.71,95%CI1.78-12.47), systemic complications(OR4.75,95%CI1.76-12.85) and pulmonaryfailure(OR4.60,95%CI1.65-12.81). During the course of AP, infection time iscorrelated with the mortality of AP and can be used as a prognostic factor for themortality of AP. At the optimum cut-off level of <12day, the time betweensymptoms onset and the diagnosis of infection predicted the mortality withsensitivity, specificity, positive predictive value and negative predictive value of85.00%,54.90%,42.50%,92.32%respectively. The diagnostic efficacy of theinfection time is similar to that of the APACHE-II score.ConclusionsOverweight, obesity, hepatic steatosis and the time between symptoms onsetand the diagnosis of infection all indicate a poor prognosis of AP and can beapplied as risk factor or prognostic factor for the prognosis of AP.