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Prediction Models of Severity in Acute Biliary Pancreatitis
Iulia Ratiu1,2, Renata Bende1,2, Camelia Nica1,2
1Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania.
Insights
A multiparametric model combining CTSI score, BISAP score, and CRP levels accurately predicts acute pancreatitis severity. This approach enhances early risk assessment for better patient management and outcomes.
Area of Science:
- Gastroenterology
- Medical Diagnostics
- Clinical Prognosis
Background:
- Acute pancreatitis presents a variable prognosis, with severe cases leading to increased morbidity and mortality.
- Early risk stratification is essential for effective management of acute pancreatitis.
- Identifying reliable prognostic markers aids in optimizing treatment strategies.
Purpose of the Study:
- To compare various prognostic markers for acute pancreatitis.
- To identify the most effective predictors of disease severity.
- To evaluate the utility of a multiparametric model for predicting acute pancreatitis severity.
Main Methods:
- Retrospective analysis of 108 patients with acute biliary pancreatitis.
- Severity stratification using the revised Atlanta criteria.
- Univariate and multivariate analyses of prognostic markers including Balthazar score, glucose, CTSI, CRP, BISAP, Ranson, and leukocytosis.
Main Results:
- The multiparametric model incorporating CTSI score, BISAP score, and CRP levels at 48 hours demonstrated high predictive accuracy (AUC-0.96).
- Individual predictors with high AUCs included BISAP score (0.91), CRP at 48h (0.92), mCTSI (0.94), and CTSI score (0.93).
- Several parameters, including Balthazar score, glucose, CTSI, CRP, BISAP, Ranson, and leukocytosis, were associated with moderate-severe pancreatitis (p < 0.05).
Conclusions:
- A multiparametric prediction model significantly improves the accuracy of severity prediction in acute biliary pancreatitis.
- The combination of CTSI score, BISAP score, and CRP levels offers a robust tool for early risk assessment.
- Accurate prediction of severity enables timely and appropriate clinical interventions.
Abstract:
Background: Acute pancreatitis is a common condition with a variable prognosis. While the overall mortality rate of acute pancreatitis is relatively low, ranging between 3 and 5% in most cases, severe forms can result in significantly higher morbidity and mortality. Therefore, early risk assessment is crucial for optimizing management and treatment. The aim of the present study wasto compare simple prognostic markers and identify the best predictors of severity in patients with acute pancreatitis. Material and Methods: A retrospective analysis was carried outon 108 patients admitted in our center during one year with acute biliary pancreatitis. Acute pancreatitis severity was stratified based on the revised Atlanta criteria. Results: 108 subjects (mean age of 60.1 ± 18.6, 65.7% females) diagnosed with acute biliary pancreatitis were included. Based on the Atlanta criteria, 59.3% (64/108) of the subjects were classified as having mild acute biliary pancreatitis, 35.2% (38/108) as having a moderate-severe pancreatitis, and 5.5% (6/108) were classified as having severe acute pancreatitis. In univariate analysis, the following parameterswere associatedwith at least a moderate-severe form of acute pancreatitis: Balthazar score, fasting blood glucose (mg/dL), modified CTSI score, CRP values at 48 h, BISAP score at admission, CTSI score, Ranson score, duration of hospitalization (days), and the presence of leukocytosis (×1000/µL) (all p < 0.05).BISAP score at admission (AUC-0.91), CRP levels at 48 h (AUC-0.92), mCTSI (AUC-0.94), and CTSI score (AUC-0.93) had the highest area under the curve (AUC) for predicting the severity of acute pancreatitis. In multivariate analysis, the model including the following independent parameters was predictive for the severity of acute pancreatitis: CTSI score (p < 0.0001), BISAP score (p = 0.0082), and CRP levels at 48 h (p = 0.0091), respectively. The model showed a slightly higher AUC compared to the independent predictors (AUC-0.96). Conclusions: The use of a multiparametric prediction model can increase the accuracy of predicting severity in patients with acute biliary pancreatitis.
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