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Predicting Persistent Acute Respiratory Failure in Acute Pancreatitis: The Accuracy of Two Lung Injury Indices
Lan Li1, Shiyu Liu1, Xiaoying Zhang1
1West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China.
Insights
The simplified Lung Injury Prediction Score (sLIPS) accurately predicts persistent acute respiratory failure (PARF) in acute pancreatitis (AP) patients. sLIPS outperforms other scoring systems, aiding early risk identification.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Gastroenterology
Background:
- Early identification of acute pancreatitis (AP) patients at risk for persistent acute respiratory failure (PARF) is critical.
- Accurate prediction of PARF aids timely intervention and improves patient outcomes.
Purpose of the Study:
- To evaluate the accuracy of the simplified Lung Injury Prediction Score (sLIPS) and simplified Early Acute Lung Injury (sEALI) in predicting PARF in AP patients.
- To compare the predictive performance of sLIPS and sEALI against existing clinical scoring systems.
Main Methods:
- Analysis of consecutive AP patients from two cohorts (training: n=912, validation: n=1033).
- PARF defined as arterial blood oxygen/inspired oxygen ratio < 300 mmHg for > 48 hours.
- sLIPS and sEALI calculated on admission using clinical data.
Main Results:
- PARF incidence was 16% in the training cohort and 22% in the validation cohort.
- sLIPS ≥ 2 accurately predicted PARF in both cohorts (AUROC 0.87 and 0.81).
- sLIPS demonstrated significantly higher accuracy than sEALI and current scoring systems (P < 0.05).
Conclusions:
- The sLIPS is a highly accurate tool for predicting PARF in AP patients using readily available clinical data.
- sLIPS surpasses sEALI and existing scoring systems in predictive performance for PARF in AP.
- sLIPS facilitates early risk stratification for PARF in hospitalized AP patients.
Background/Aims:
Early and accurate identification of patients with acute pancreatitis (AP) at high risk of persistent acute respiratory failure (PARF) is crucial. We sought to determine the accuracy of simplified Lung Injury Prediction Score (sLIPS) and simplified Early Acute Lung Injury (sEALI) for predicting PARF in ward AP patients.
Methods:
Consecutive AP patients in a training cohort from West China Hospital of Sichuan University (n = 912) and a validation cohort from The First Affiliated Hospital of Nanchang University (n = 1033) were analyzed. PARF was defined as oxygen in arterial blood/fraction of inspired oxygen < 300 mmHg that lasts for > 48 h. The sLIPS was composed by shock (predisposing condition), alcohol abuse, obesity, high respiratory rate, low oxygen saturation, high oxygen requirement, hypoalbuminemia, and acidosis (risk modifiers). The sEALI was calculated from oxygen 2 to 6 L/min, oxygen > 6 L/min, and high respiratory rate. Both indices were calculated on admission.
Results:
PARF developed in 16% (145/912) and 22% (228/1033) (22%) of the training and validation cohorts, respectively. In these patients, sLIPS and sEALI were significantly increased. sLIPS ≥ 2 predicted PARF in the training (AUROC 0.87, 95% CI 0.84-0.89) and validation (AUROC 0.81, 95% CI 0.78-0.83) cohorts. sLIPS was significantly more accurate than sEALI and current clinical scoring systems in both cohorts (all P < 0.05).
Conclusions:
Using routinely available clinical data, the sLIPS can accurately predict PARF in ward AP patients and outperforms the sEALI and current existing clinical scoring systems.
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