| Purpose: Acute pancreatitis(AP)is a common disease of digestive system.The incidence of AP is increasing year by year,which progresses rapidly.The severity of AP varies greatly among individuals.The mild AP can be alleviated by itself,while the severe AP can cause death.The mortality rate of severe acute pancreatitis(AP)is 20–30%,even after admission to intensive care unit(ICU).Thus we aimed to develop a laboratory-based nomogram to identify AP patients at high risk for mortality,Aiming at facilitating clinicians to timely assess the severity of patients and make the best treatment decisions,in order to reduce the mortality rate of patients.Materials and methods: The primary and validation cohorts were extracted from the Medical Information Mart for Intensive Care III database(MIMIC-III).we collected the corresponding basic demographic information,physical examination information,laboratory examination indicators and other data.The main endpoint of this study was the all-cause death of patients with acute pancreatitis.Univariate analysis was used to determine the risk factors related to death.Independent predictors were determined using multiple Cox analysis and then assembled to predict survival.Then they are combined by R language software to form a nomogram model for evaluating the prognosis of patients.The performance of proposed nomogram was evaluated by Harrell's concordance index(C-index)and area under the receiver operating characteristic(AUC)analysis,and subsequently compared with conventional scoring systems.Results: 1.A total of 342 AP patients admitted to ICU were enrolled,They were randomly divided into primary cohort(228)and validation cohort(114).2.In the primary cohort,through univariate regression analysis of the related clinical indicators of patients,the factors related to mortality risk were obtained.Further,the confounding factors were screened out by multivariate COX regression model analysis,and multiple independent predictive indicators were obtained,with 30-day,180-day and 1-year mortality rate of 10.8%,16.1% and 17.5%,respectively.3.The risk factors of death were as follows: age,white blood cells,red blood cell distribution width(RDW),lymphocyte-monocyte ratio(LMR),albumin,glutamic pyruvic transaminase and blood urea nitrogen were the main factors affecting 30-day mortality.Age,white blood cells,RDW,neutrophil-lymphocyte ratio(NLR),LMR,albumin,serum creatinine and blood urea nitrogen were the influencing factors of 180-day/1-year mortality.The results of multivariate regression analysis were as follows: age,alanine aminotransferase,RDW and blood urea nitrogen were predictors of 30-day mortality in patients with acute pancreatitis,and age,white blood cells,RDW and creatinine were predictors of 1-year mortality.4.RDW is an independent prognostic factor for death in patients with acute pancreatitis,and the mortality rate is higher in patients with RDW greater than 13.8.5.Based on the difference of independent predictors of short-term and long-term mortality,independent factors from multivariate Cox model to prognosticate 30-day and 1-year mortality were retrieved.The C-index of 1-year prediction nomogram(0.758,95%CI:0.676–0.840)were superior to several prediction approaches,and these findings were further confirmed by applying time-specific AUC analysis.Decision curve analysis indicated our nomogram was feasible in clinical practice.6.Similar results were observed in the validation cohort.Conclusions: The proposed nomogram gives rise to accurately prognostic prediction for critically AP patients admitted to ICU. |
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