Potential Clinical Predictors And Prognostic Analysis Of Severe Acute Pancreatitis

Background and objective:Acute pancreatitis（AP）is a clinically common internal emergent disease,which is divided into moderate acute pancreatitis（MAP）,moderate severe acute pancreatitis（MSAP）and severe acute pancreatitis（SAP）in accordance with International General Revision Atlanta Classification（RAC）as the standard of AP severity.AP patients with combined organ failure or local/systematic complications upon admission will develop into MSAP or SAP with the course of the disease.Currently,there is still lack of the indicators for early judgement of SAP patients among these non-moderate AP patients.In this study,158 AP patients with combined organ failure or local/systematic complications upon admission were retrospectively studied and divided into MSAP group and SAP group according to the progression of the disease.Their clinical characteristics were compared and analyzed so as to find an early warning marker,hoping to provide reference for AP early risk stratification,timely intervention and prognostic evaluation.Methods:This study included AP patients admitted to Hepatic-biliary-pancreatic Medicine Department and ICU of First Hospital of Jilin University from January 1,2019 to December31,202,and diagnosed as AP for the first time,with combined organ failure or local/systematic complications upon admission.The general condition,laboratory examination within 24 h of admission,local and systemic complications,and prognosis within 24 h of admission of MSAP and SAP patients that met RAC standards were collected and comparatively analyzed using R 4.1.1 software.Results:1.Among 99 cases in MSAP group,there were 63 men,accounting for 63.6%,36 women,accounting for 36.4%,average age of 43.1 years;Among 59 cases in SAP group,there were 40 men,accounting for 67.8%,19 women,accounting for 32.2%,an average age of 41.1 years.In accordance with pathogenesis,26 cases were biliary-derived（16.5%）,46 cases were adipose-derived（29.1%）,10 cases were alcoholic-derived（6.3%）.According to the transfer at discharge,146 cases were improved（92.4%）,12 cases died（7.6%）,and all dead patients were severe acute pancreatitis patients.2.The procalcitonin,C-reaction protein,Aspartate aminotransferase,direct bilirubin,urea,creatinine,activates partial thromboplastin time,prothrombin time,international standardization ratio,prothrombin time ratio,fibrinogen,triglycerides,the incidence of pleural effusion,the incidence of organ failure,the mortality and ICU transfer rate of patients in SAP group were higher than MSAP group;the LYMPH,albumin,prothrombin time activity,and the incidence of of the SAP group is absolute,the intra-thrombin is activated,blood calcium,HDL cholesterol,LDL cholesterol and the incidence of peripancreatic effusion and seroperitoneum in SAP were lower than MSAP group.3.Patients in SAP group were divided into improvement group and death group,including 47 patients（79.7%）and 12 patients（20.3%）respectively.The average age,total bilirubin,direct bilirubin,creatinine,aspartate aminotransferase,alanine aminotransferase,Urea,amylase,incidence of circulatory failure,incidence of more organ failure were lower than death group;the hospital stays,platelet,platelet specific volume and fibrinogen,triglycerides,cholesterol,incidence of peripancreatic effusion,incidence of renal failure,and the incidence of single and two organ failure were higher than death group.Conclusion:1.The procalcitonin,C-reactive protein,direct LYMPH,international normalized ratios,serum triglyceridesand can be used to make potential clinical predictions and the combination of the above five indicators may be conductive to the preliminary screening of SAP patients.2.The aspartate aminotransferase,alanine aminotransferase,platelets,platelet specific capacity,total bilirubin,direct bilirubin,creatinine,urea,fibrinogen,triglycerides,cholesterol,amylase may be helpful in evaluating the prognosis of patients with SAP.