Objective To construct a nomogram prediction model for the progression of patients with acute pancreatitis(AP)to severe acute pancreatitis(SAP),and to explore its application value in predicting the progression of severe AP.Methods According to the 2012 Atlanta classification criteria,264 patients with AP were divided into SAP group(96 cases)and non-SAP(NSAP)group(168 cases).Clinical indicators,laboratory data and Ranson scores were compared between the two groups.LASSO regression method was used to screen predictors,and a nomogram(n-Ranson score)was constructed to predict the development of SAP.C-index,calibration curve and clinical decision curve analysis(DCA)were used to evaluate the performance,fit and clinical practicability of the n-Ranson score.Results WBC count,mean platelet volume(MPV),serum amylase(AMY),serum lipase(LIPA),C-reactive protein(CRP),platelet specific volume(PCT),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),glutamyltransferase(GGT),blood glucose(Glu),AST and the proportion of patients＞60 years old in SAP group were higher than those in NSAP group,while RBC count,hematocrit(HCT),Hb,serum albumin(Alb),estimated glomerular filtration rate(eGFR)and the proportion of patients with drinking history were lower than those in NSAP group;there was statistically significant difference in the constituent ratio of patients with different Ranson scores between the two groups(P＜0.05).The results of LASSO regression cross-validation showed that NLR,eGFR and Ranson score were independent predictors of SAP(P＜0.05).Based on the above three variables,the n-Ranson sccore prediction model was constructed.The results showed that the C-index of the n-Ranson score was 0.911(95％CI 0.873～0.950),and the corrected C-index was 0.908,indicating that it had a relatively accurate prediction ability.The Bootstrap method internally verified that the n-Ranson score had a high consistency with the actual clinical AP severity curve,and the prediction effect was better than that of the Ranson score.Conclusion N-Ranson score nomogram prediction model based on NLR,eGFR,and Ranson score has a certain predictive value for the severity of AP.
维普
万方数据
