摘要
目的 呼吸衰竭(respiratory failure,RF)增加急性胰腺炎(acute pancreatitis,AP)的死亡率.本研究目的是在确定急性胰腺炎患者早期发生呼吸衰竭的预测因子,用于疾病发展的早期干预.方法 选取合肥市第二人民医院急诊科2018年01月至2023年11月收治的诊断为急性胰腺炎患者162例.收集入院时完整的临床特征.2012年修订的亚特兰大分类诊断为急性胰腺炎,采用单因素和多因素分析选择危险因素,ROC分析显示血清白蛋白和血钙对预测急性胰腺炎患者早期发生呼吸衰竭具有较好的辨别力.结果 本研究共纳入162名符合标准的急性胰腺炎患者,年龄66.29±13.07岁,男94例(58.02％),女68例(41.98％).胆源性胰腺炎124例,酒精性胰腺炎15例,高脂血症性胰腺炎19例,不明原因4例.其中26例患者在48小时内发生呼吸衰竭,分RF组;136例患者在48小时内未合并呼吸衰竭,分为非RF组.RF组急性胰腺炎重症评分和呼吸机使用率均高于非RF组,RF组的死亡率是非RF组的13.92倍(30.77％vs 2.21％,P＜0.01).经单因素和logis-tic多因素分析均表明血清白蛋白和血清钙是急性胰腺炎早期呼吸衰竭的独立危险因素(P＜0.05).ROC曲线分析表明,血清白蛋白和血清钙可以预测急性胰腺炎发生呼吸衰竭,曲线下面积(AUC)分别为0.809和0.774;ROC分析中使用约登指数(Youden's index)来找最佳临界值,血清白蛋白为24.8g/L,血钙为1.92 mmol/L.以此构建的模型经Bootstrap验证,具有较好的判别程度.校准曲线表明,模型具有较好的一致性.结论 本研究表明患者入院48小时内血清白蛋白最差值＜24.8g/L、血钙＜1.92 mmol/L可用于预测急性胰腺炎发生呼吸衰竭,准确率高.
Abstract
Objective Respiratory failure(RF)increases mortality in acute pancreatitis(AP).The purpose of this study was in identifying predictors of early onset of respiratory failure in patients with acute pancreatitis for early intervention in disease progres-sion.Methods A total of 162 patients with a diagnosis of acute pancreatitis admitted to the emergency department of the Second Peo-ple's Hospital of Hefei City from January 01,2018 to November 2023 were selected.Complete clinical characteristics were collected at the time of admission.The 2012 revised Atlanta classification was used to diagnose acute pancreatitis,and risk factors were selected u-sing unifactorial and multifactorial analyses.ROC analysis showed that serum albumin and blood calcium had good discriminatory power in predicting the early occurrence of respiratory failure in patients with acute pancreatitis.Results A total of 162 patients with acute pancreatitis meeting the criteria were included in this study,aged 66.29±13.07 years,94 cases(58.02％)were male and 68 cases(41.98％)were female.There were 124 cases of biliary pancreatitis,15 cases of alcoholic pancreatitis,19 cases of hyperlipidemic pancreatitis and 4 cases of unknown causes.Among them,26 patients developed respiratory failure within 48 hours and were divided into RF group;136 patients did not have combined respiratory failure within 48 hours and were divided into no-RF group.Acute pancre-atitis severity scores and ventilator utilization were higher in RF group than in no-RF group,and mortality rate was 13.92 times higher in RF group than in no-RF group(30.77％vs.2.21％,P＜0.01).Both one-way and logistic multifactorial analyses showed that ser-um albumin and serum calcium were independent risk factors for early respiratory failure in acute pancreatitis(P＜0.05).ROC curve analysis showed that serum albumin and serum calcium predicted the development of respiratory failure in acute pancreatitis,with an area under the curve(AUC)of 0.809 and 0.774,respectively,the use of Youden's index in the ROC analysis(Youden's index)was used in the ROC analysis to find the optimal critical values,which were 24.8 g/L for serum albumin and 1.92 mmol/L for serum calci-um,respectively.The model constructed in this way is validated by Bootstrap and has a good degree of discrimination.The calibration curves show that the model has a better consistency.Conclusion This study demonstrated that serum albumin worst value＜24.8 g/L and blood calcium＜1.92 mmol/L within 48 hours of a patient's admission to the hospital can be used to predict the development of re-spiratory failure in acute pancreatitis with a high degree of accuracy.
维普
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