A Study On Analysis Of Death Factors And Prognosis Assesement In Patients With Fulminant Acute Pancreatitis

Objectives:1. To analyze the death factors in patients with fulminant acute pancreatitis (FAP) for mortality reduction.2. To assess the value of two scoring criteria (Ranson and APACHE II) in patients with FAP,and to expect more effectively therapies.Methods:The clinical data of 26 patients with FAP in The First Affiliated Hospital of Chongqing Medical University from January 2006 to May 2009 were collected and retrospectively analyzed. The data contained the general information, clinical manifestations, assistant examination results, and therapeutic measures of the patients. All the patients were divided into 2 groups,the death group and the survival group . The date underwent statistic analysis.Results:1.Univariate analysis showed that there were significant differences in no catharsis within 24 hours, shock, shock index, coma, or oxygenation index between the survival group and the death group(P<0.05).There were very significant differences in Serum creatinine, urea nitrogen, prothrombin time, international normalized ratio, D-dimer, blood creatine kinase, blood pH, arterial base excess, bicarbonate, the number of organ dysfunction, a single organ dysfunction, four or more organ dysfunction, multiple organ dysfunction syndrome, acute renal failure, hemofiltration between the two groups.2. Multivariate analysis showed that the number of organ dysfunction which was an independent death factor of FAP was the mostly closed relationship with the prognosis of FAP. The regression equation was ln(P/(1-P))=-3.61+1.56X. P was the mortality of FAP, and X was the number of organ dysfunction.3. There were very significant differences in RASSON, APACHE II score. Within 48 hours between the two groups .To judge the two assessment of standard, ROC curve showed: RASSON score : AUC 0.785, Youden index 0.545, the sensitivity 1.000, the specificity 0.545, the threshold value 7 points, there were significant differences (P<0.05); APACHE II score: AUC 0.945, Youden index 0.751, the sensitivity 0.933, the specificity 0.818, the threshold value 20 points, there were very significant differences(P<0.05); The latter one was better than the former one on the assessment of the prognosis of FAP.Conclusions:1. no catharsis within 24 hours, shock, shock index, coma, oxygenation index, acute renal failure, serum creatinine, urea nitrogen, prothrombin time, international normalized ratio, D-dimer, blood CK-MB, blood pH, arterial base excess, bicarbonate, the number of organ dysfunction, single organ dysfunction, four or more organ dysfunction, multiple organ dysfunction syndrome, the number of hemofiltration were the death factors of FAP. The number of organ dysfunction was an independent death factor of FAP and was the mostly significantly related to the prognosis of FAP. The regression equation was ln(P/(1-P))=-3.61+1.56X. P was the mortality of FAP, and X was the number of organ dysfunction. It could expect the mortality probability. To maintain intestinal smooth, internal environment stable and coagulation function normal, and to protect multiple organ function, especially circulatory system , renal and cerebral function , to use ventilation and hemofiltration, play critical role in the mortality reduction for FAP.2. Within 48 hours of admission, RASSON and APACHE II scoring criteria ,were meaningful for the assessment of the severity and the judgement of the prognosis; RASSON score≥7points ,APACHE II score≥20points,it meant a poor prognosis; APACHE II score was thought to be more accurate and helpful for a reasonable and in time treatment. The two score criterias together would be more valuable for the judgement of the prognosis of FAP.