Impact of Etiology on Predictive Models for Acute Pancreatitis Severity: A Retrospective Study

This study aimed to evaluate whether predictive variables differ by acute pancreatitis (AP) etiology and clinical outcomes.

This retrospective study included 845 AP patients diagnosed from January 2015 to December 2022 at a tertiary care hospital. Patient characteristics, scoring systems, and biomarkers were assessed to determine AP severity, with regression analysis used to identify predictor-outcome associations.

The predictors of acute biliary pancreatitis severity were creatinine (Cr) (OR=7.157, 95% CI [3.176-16.21], P≤0.0001), procalcitonin (PCT) (OR=6.061, 95% CI [2.575-14.26], P≤0.0001), and the harmless acute pancreatitis score (HAPS) (OR=3.163, 95% CI [1.363-7.340], P≤0.0073). Cr (OR=5.844, 95% CI [2.238-15.25], P≤0.0003) and systemic inflammatory response syndrome (SIRS) (OR=3.708, 95% CI [1.442-9.532], P≤0.0065) were predictors of alcoholic AP severity. SIRS (OR=9.663, 95% CI [1.904-48.74], P≤0.0062) was the sole predictor of hypertriglyceridemic AP severity. Among patients with other etiologic causes of AP, the severity predictors were Cr (OR=8.144, 95% CI [3.337-19.9], P≤0.0001), C-reactive protein (OR=5.808, 95% CI [2.186-15.43], P=0.0004), and age (OR=1.032, 95% CI [1.006-1.059], P=0.0146). The multivariable analysis identified Cr, PCT, HAPS, SIRS, and age as significant predictors of organ failure in AP, yielding and area under the curve of 0.909 with a sensitivity of 0.85 and specificity = 0.85.

This study sheds new light on early-stage AP severity prediction, emphasizing the association between predictors, etiology, and clinical outcomes.