Validation of the efficacy of the prognostic factor score in the Japanese severity criteria for severe acute pancreatitis: A large multicenter study
Validation of the efficacy of the prognostic factor score in the Japanese severity criteria for severe acute pancreatitis: A large multicenter study
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DOI：
10.1177/2050640616670566
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发表时间：
2017-04-01
影响因子：
6
通讯作者：
Mayumi, Toshihiko
中科院分区：
文献类型：
--
作者：
Ikeura, Tsukasa;Horibe, Masayasu;Mayumi, Toshihiko
背景：日本急性胰腺炎（AP）的严重程度标准，包括预后因素评分和对比增强计算机断层扫描分级，已在日本广泛使用。目的：本研究进行了大型多中心回顾性研究，以验证预后因素评分与急性生理和慢性健康评估II （APACHE II）评分对严重AP患者死亡率和并发症的预测价值。方法：回顾性收集44家医院1159例按照日本急性急性程度标准诊断为重度急性胰腺炎的患者资料。结果：预测死亡率的预后因素评分的受试者-操作特征曲线的曲线下面积（AUC）为0.78(95%可信区间（CI）， 0.74-0.82)，而APACHE II评分的AUC为0.80 （95% CI, 0.76-0.83）。两种评分系统预测死亡率的AUC无显著差异。根据修订的亚特兰大分类，预测机械通气需求、胰腺感染发展和严重AP的预后因素评分的auc分别为0.84 （95% CI, 0.81-0.86）、0.73 （95% CI, 0.69-0.77）和0.83 (95% CI, 0.81-0.86)，显著大于APACHE II评分的auc；根据修订的亚特兰大分类，需要机械通气的0.81 (95% CI, 0.78-0.83) (p=0.03)，发生胰腺感染的0.68 (95% CI, 0.63-0.72) (p=0.02)，严重AP的0.80 (95% CI, 0.77-0.82) （p=0.01）。结论：与APACHE II评分相比，预后因素评分在预测死亡率方面具有同等的能力。在预测AP临床过程中严重并发症发生的能力方面，预后因素评分可能优于APACHE II评分。
Background: The Japanese severity criteria for acute pancreatitis (AP), which consist of a prognostic factor score and contrast-enhanced computed tomography grade, have been widely used in Japan.Objective: This large multicenter retrospective study was conducted to validate the predictive value of the prognostic factor score for mortality and complications in severe AP patients in comparison to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score.Methods: Data of 1159 patients diagnosed with severe AP according to the Japanese severity criteria for AP were retrospectively collected in 44 institutions.Results: The area under the curve (AUC) for the receiver-operating characteristic curve of the prognostic factor score for predicting mortality was 0.78 (95% confidence interval (CI), 0.74-0.82), whereas the AUC for the APACHE II score was 0.80 (95% CI, 0.76-0.83), respectively. There were no significant differences in the AUC for predicting mortality between two scoring systems. The AUCs of the prognostic factor scores for predicting the need for mechanical ventilation, the development of pancreatic infection, and severe AP according to the revised Atlanta classification were 0.84 (95% CI, 0.81-0.86), 0.73 (95% CI, 0.69-0.77), and 0.83 (95% CI, 0.81-0.86), respectively, which were significantly greater than the AUCs for the APACHE II score; 0.81 (95% CI, 0.78-0.83) for the need for mechanical ventilation (p=0.03), 0.68 (95% CI, 0.63-0.72) for the development of pancreatic infection (p=0.02), and 0.80 (95% CI, 0.77-0.82) for severe AP according to the revised Atlanta classification (p=0.01).Conclusion: The prognostic factor score has an equivalent ability for predicting mortality compared with the APACHE II score. Regarding the ability for predicting the development of severe complications during the clinical course of AP, the prognostic factor score may be superior to the APACHE II score.