| ?Objective?Retrospectively analyse the clinical features of 231 patients with severe acute pancreatitis(SAP),summarize the related factors affecting the prognosis and cause of death in the patients with SAP,evaluate the predictive value of independent risk factors,help us earlily evaluate prognosis,direct clinical treatment and reduce mortality.?Methods?Review the clinical data of 2993 patients with acute pancreatitis(AP)admitted to the First Affiliated Hospital of Soochow University from November 2006 to November 2016 retrospectively,among than clinical data of 231 patients with SAP based on the Revised version of Atlanta classification(RAC)were collected and analyzed.All patients were divided into death group and survival group according to their outcome.Comparing the difference in the age,sex,concomitant diseases,etiology,incidence of disease,relevant laboratory data,bedside Index of severity in acute pancreatitis(BIASP),acute physiology and chronic health evaluation(APACHE?),modified CT severity index(MCTSI),incidence of local and systemic complications during hospitalization between two groups.Measurement data using t test or Mann-Whitney U test,enumeration data using X2 test,Screening the independent risk factors for predicting death in the patients with SAP by two-element Logistic regression analysis,and the ROC curve was drawn to evaluate the predictive value of independent risk factors and determine the truncation value.The most important cause of death in the patients with SAP was analyzed by multiple factor two-element Logistic regression analysis.?Results?(1)There were 55 patients in death group and 176 patients in survival group,the age in the death group was higher than that in the survival group(62.49±18.54 vs 53.48±18.02),the difference was statistically significant(P<0.05).(2)The serum creatinine(Cr),urea nitrogen(BUN)and procalcitonin(PCT),BISAP score,APACHE score,MCTSI score in the death group were higher than that in the survival group,the difference was statistically significant(P<0.05);hematocrit(HCT),albumin(ALB)PH,oxygenation index(OI)were lower than that in the survival group,the difference was statistically significant(P<0.05);(3)In the death group all the patients were complicated with multiple organ dysfunction,incidence rate were significantly higher than the survival group(100% vs 59.1%),the difference was statistically significant(P<0.05);In the death group the patients complicated with SIRS(80.0%),sepsis(34.5%),respiratory dysfunction(92.7%)gastrointestinal dysfunction(100%),hepatic dysfunction(63.6%),renal dysfunction(65.5%),cardiovascular dysfunction(58.2%),blood system disorders(41.8%)were higher than that in the survival group,the difference was statistically significant(P<0.05).(4)two-element Logistic regression analysis showed that the APACHE score,BISAP score may be an independent risk factor for the prognosis of patients with SAP,the cut-off value of APACHE II = 17,the sensitivity and specificity of predicting death were 94.5% and 93.2% respectively,the cut-off value of BISAP score = 3,and the sensitivity and specificity of predicting death were 92.7% and 58.0% respectively;(5)two-element Logistic regression analysis of complications revealed that renal dysfunction and cardiovascular dysfunction were closely related to the cause of death in the patients with SAP,and the risk factors for death(OR = 7.43,4.98,P<0.01).?Conclusions?(1)The age and chemistry data of blood(HCT,Cr,BUN,ALB,PCT,PH,OI)and MCTSI score Can help us to judge the prognosis in the patients with SAP;(2)APACHE II score and BISAP score are independent risk factors for prognosis of patients with SAP,It has a good predictive value for death risk of this disease,the predictive value of APACHE II score is better than that of BISAP score;(3)Multiple organ dysfunction syndrome(MODS)is the main cause of death in patients with SAP,renal dysfunction and cardiovascular dysfunction are the most important causes of death. |
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