Predicting the clinical manifestations in necrotizing acute pancreatitis patients with splanchnic vein thrombosis
Predicting the clinical manifestations in necrotizing acute pancreatitis patients with splanchnic vein thrombosis
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DOI：
10.1016/j.pan.2016.10.001
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发表时间：
2016-11-01
期刊：
影响因子：
3.6
通讯作者：
Li, Jieshou
中科院分区：
文献类型：
--
作者：
Zhou, Jing;Ke, Lu;Li, Jieshou
背景：内脏静脉血栓形成（SVT）是坏死性急性胰腺炎（NAP）相对罕见但重要的并发症。不同患者的临床表现和严重程度差异很大，从轻微的腹部不适甚至无症状到致命的胃出血或肝功能衰竭。本研究的目的是建立一个预测NAP患者SVT临床表现的模型。方法：在金陵医院外科重症监护病房（SICU）进行回顾性队列研究。同时存在胰腺坏死和SVT的患者被选为可能的纳入对象。采用单因素和多因素logistic回归分析，包括年龄、性别、急性生理和慢性健康评估H评分（APACHE II）、CRP（C -反应蛋白）水平等12项指标，评估该队列中症状性胰腺-胰腺静脉血栓形成（PSVT）的潜在预测因素。我们还应用了预后nomogram来开发一个易于使用的预测模型。结果：2012年1月至2013年12月共纳入104例坏死性急性胰腺炎（NAP）合并内脏静脉血栓形成（SVT）患者进行分析。四分之一的研究对象（104,25%中的26人）在疾病过程中出现各种症状表现，包括静脉曲张出血、持续腹水和肠内营养（EN）不耐受。在多变量回归模型中，发现以下因素与症状性SVT的发生相关：Balthazar计算机断层扫描（CT）评分（OR = 1.818; 95% CI: 1.251 ~ 2.641; P = 0.002）、腹内压（IAP） （OR = 1.172; 95% CI: 1.001 ~ 1.251; P = 0.043）和SMVT的存在（OR = 6.946; 95% CI: 2.290 ~ 21.074; P = 0.001）。综合这些因素的预测模型显示，受试者工作特征曲线下的面积为0.842。结论：Balthazar CT评分、IAP和SMVT是NAP患者症状性SVT的预测指标。我们所做的nomogram可以作为一种易于使用的风险分层工具用于临床实践或未来的研究。（三）2016年IAP和EPC。Elsevier B.V.版权所有。
Background: Splanchnic venous thrombosis (SVT) is a relatively rare but important complication of necrotizing acute pancreatitis (NAP). Clinical manifestations and severity of this complication in different patients vary greatly, ranging from mild abdominal discomfort even asymptomatic to lethal gastrorrhagia or hepatic failure. The aim of the present study was to develop a model to predict the clinical manifestations of SVT in NAP patients.Methods: This retrospective cohort study was conducted in the surgical intensive care unit (SICU) of Jinling Hospital. Patients with the presence of both pancreatic necrosis and SVT were selected for possible inclusion. Both univariate and multivariate logistic regression analyses were applied using 12 indices including age, gender, Acute Physiology and Chronic Health Evaluation H scores (APACHE II), CRP(C - reactive protein) levels, etc to assess potential predictors for symptomatic pancreatic splanchnic venous thrombosis (PSVT) in this cohort. A prognostic nomogram was also applied to develop an easy-to use prediction model.Results: A total of 104 patients with necrotizing acute pancreatitis (NAP) and splanchnic vein thrombosis (SVT) from January 2012 to December 2013 were enrolled for analysis. A quarter of study subjects (26 of 104, 25%) developed variable symptomatic manifestations including variceal bleeding, persistent ascites and enteral nutrition (EN) intolerance during the disease course. In the multivariable regression model, the following factors were found to be associated with the occurrence of symptomatic SVT: Balthazar's computed tomography (CT) score (OR = 1.818; 95% CI: 1.251-2.641; P = 0.002), intra-abdominal pressure (IAP) (OR = 1.172; 95% CI: 1.001-1.251; P = 0.043 and presence of SMVT (OR = 6.946; 95% CI: 2.290 21.074; P = 0.001). A prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.842.Conclusions: Balthazar's CT score, IAP and SMVT are predictors of symptomatic SVT in NAP patients. The nomogram we conducted can be used as an easy-to-use risk stratification tool in either clinical practice or future studies. (C) 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.