Construction and validation of a predictive model for in-hospital mortality in elderly patients with severe acute pancreatitis
Objective To develop and validate a predictive model for in-hospital mortality in elderly patients with severe acute pancreatitis(SAP).Methods A total of 368 elderly SAP hospital-ized patients were selected as study objects,and were divided into mortality group(96 patients,26.09％)and survival group(272 patients,73.91％)based on their survival status during hospital-ization.Multivariable Logistic regression analysis was performed to identify influencing factors associ-ated with in-hospital mortality in SAP patients,and a predictive model was constructed based on these factors.Receiver operating characteristic(ROC)curves were plotted,and the predictive performance of the model was evaluated using the area under the curve(AUC),accuracy,sensitivity,and speci-ficity.Results Univariate analysis revealed that the mortality group had a higher proportion of pa-tients aged over 60 years,with renal insufficiency,coronary heart disease,and undergoing laparo-scopic surgery.Additionally,the mortality group had significantly higher levels of red blood cell dis-tribution width,fasting blood glucose,interleukin-6,procalcitonin,neutrophil-to-lymphocyte ratio(NLR),lactate,modified CT severity index(MCTSI)score,and bedside index for severity in acute pancreatitis(BISAP)score compared to the survival group(P＜0.05).Multivariable Logistic regression analysis identified age,renal insufficiency,MCTSI score,fasting blood glucose,and NLR as independent influencing factors of in-hospital mortality in elderly SAP patients(P＜0.05).A regression equa-tion was constructed based on these factors:C-index=-1.569+0.258 x(age)+0.334 x(renal insufficiency)+0.672 x(MCTSI score)+0.281 x(fasting blood glucose)+0.410 x(NLR).The ROC curve analysis showed that the AUC of the model for predicting in-hospital mortality in elderly SAP patients was 0.877(95％CI,0.840 to 0.915),with an accuracy of 84.23％,sensitivity of 75.00％,and specificity of 87.50％.Conclusion Age,renal insufficiency,MCTSI score,fasting blood glucose,and NLR are independent predictors of in-hospital mortality in elderly SAP patients.The predictive model constructed based on these factors can assist in identifying high-risk patients and predicting all-cause mortality risk in SAP.
middle-aged and elderly patientssevere acute pancreatitismortalitypredic-tive modelrenal insufficiency
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