Factors predicting the severity of acute pancreatitis in elderly patients
Factors predicting the severity of acute pancreatitis in elderly patients
复制标题
DOI：
10.1007/s40520-020-01523-1
复制
发表时间：
2020-03-17
影响因子：
4
通讯作者：
Zhang, Mei
中科院分区：
文献类型：
--
作者：
He, Fang;Zhu, Hong-ming;Zhang, Mei
研究背景中重度急性胰腺炎（MSAP）和重症急性胰腺炎（SAP）均伴有器官功能衰竭（OF），可导致死亡。目的：本研究旨在确定老年患者入院时AP严重程度的预测因素。方法回顾性分析60岁以上老年患者在发病后72 h内无OF的临床资料。对入院时的这些数据进行分析，并与AP的严重程度进行相关性分析。为了确定与更严重AP（即MSAP和SAP）相关的因素，将患者分为轻度急性胰腺炎（MAP）组和MSAP + SAP组。结果共纳入198例患者，其中MAP组135例，MSAP + SAP组63例。胆道疾病是最常见的病因。呼吸衰竭是最常见的OF。Logistic回归分析表明，特发性病因（比值比[OR]：3.029，95%置信区间[CI]：1.017-9.022，p = 0.047），既存肺部疾病（OR：7.104，CI 1.750-28.84，p = 0.006），红细胞压积水平升高（OR：3.717，95%CI 1.372-10.070，p = 0.010），血清钙（OR：0.023，95%CI 0.001-0.371，p = 0.008），血糖（OR：1.157，95%CI 1.031-1.299，p = 0.013），动脉血氧分压（PaO 2）（OR：0.914，95%CI 0.874-0.956，p < 0.001）和胸腔积液（OR：4.979，95%CI 1.863-13.303，p = 0.001）是更严重AP的独立预测因素。结论老年AP患者入院时的特发性病因、既往肺部疾病、红细胞压积升高或胸腔积液、血糖升高、血钙或PaO 2降低与病情加重独立相关。
Background Moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) are associated with organ failure (OF), which can be lethal. Aims This study determined the factors that predict the severity of AP at admission in elderly patients. Methods In this retrospective study, the data from elderly patients (> 60 years of age) admitted within 72 h of onset of symptoms without OF were collected. These data at admission were analyzed and correlated with the severity of AP. To identify the factors associated with more serious AP (i.e. MSAP and SAP), patients were divided into mild acute pancreatitis (MAP) and MSAP + SAP groups. Results A total of 198 patients [MAP group (n = 135) and MSAP + SAP group (n = 63)] were included. Biliary disease was the most common etiology. Respiratory failure was the most common OF. Logistic regression analyses indicated that idiopathic etiology (odds ratio [OR]: 3.029, 95% confidence interval [CI]: 1.017-9.022, p = 0.047), pre-existing pulmonary disease (OR: 7.104, CI 1.750-28.84, p = 0.006), increased hematocrit level (OR: 3.717, 95%CI 1.372-10.070, p = 0.010), serum calcium (OR: 0.023, 95%CI 0.001-0.371, p = 0.008), serum glucose (OR: 1.157, 95%CI 1.031-1.299, p = 0.013), arterial partial pressure of oxygen (PaO2) (OR: 0.914, 95%CI 0.874-0.956, p < 0.001), and pleural effusion (OR: 4.979, 95%CI 1.863-13.303, p = 0.001) were independent predictors of more serious AP. Conclusion This study found that idiopathic etiology, pre-existing pulmonary diseases, increased hematocrit level or pleural effusion, higher serum glucose, and lower serum calcium or PaO2 at the time of admission independently correlated with more serious AP in the elderly patients.