Predictive values of indicators for withdrawal outcome in patients with severe acute pancreatitis complicated with acute respiratory distress syndrome
Objective To explore the predictive values of oxygenation index,positive end expiratory pressure (PEEP),Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ),serum amylase,C-reactive protein (CRP) for withdrawal outcome in patients with severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS). Methods A total of 84 patients with SAP complicated with ARDS admitted to the East branch of Ningbo Medical Center. Lihuili Hospital of from December 2015 to July 2023 were retrospectively selected as the study objects,and the patients were randomly assigned to the training set (n=59) and the test set (n=25) according to a ratio of 7:3. Whether the patients in the training set underwent mechanical ventilation again within 48 h after extubation was used as the evaluation criterion for the withdrawal outcome. Multivariate logistic regression was used to analyze the influencing factors for the withdrawal failure of patients in the training set. Furthermore,ROC curve was used to evaluate the predictive efficacy of oxygenation index,PEEP,combined with APACHE Ⅱ score,serum amylase and CRP on withdrawal failure. The influencing factors screened out by multivariate logistic regression analysis were used to draw a nomogram,and the nomogram model was used to predict the withdrawal failure of patients to verify its consistency. Results There were 44 successful cases and 15 failed cases,with a successful withdrawal rate of 74.6％. Compared with the successful withdrawal group,APACHE Ⅱ score,PEEP,serum amylase and CRP in the failed withdrawal group were significantly increased,while oxygenation index was significantly decreased (all P<0.05). Multivariate logistic regression analysis showed that PEEP,APACHE Ⅱ score,serum amylase and CRP were independent risk factors for withdrawal failure in SAP patients with ARDS (all P<0.05),while oxygenation index was an independent protective factor (P<0.05). ROC curve analysis showed that the AUC of combined prediction of oxygenation index,PEEP,APACHE Ⅱ score,serum amylase and CRP was 0.982,which was higher than the results of any single index. The calibration curves of both the training set and the test set showed that the actual observation was in good consistency with the prediction of the nomogram. The survival rate of successful withdrawal group was significantly higher than that of the failed withdrawal group (P<0.001). Conclusion PEEP,APACHE Ⅱ score,serum amylase and CRP are independent risk factors affecting the withdrawal outcome of SAP patients with ARDS,while oxygenation index is an independent protective factor. The combination of the above five indicators shows good predictive value. In addition,the constructed nomogram prediction model has good predictive performance,which can provide references for clinicians to evaluate the indications of extubation.
Severe acute pancreatitisAcute respiratory distress syndromeWithdrawalOxygenation indexPositive end expiratory pressureAcute Physiology and Chronic Health Evaluation ⅡSerum amylaseC-reactive protein
万方数据
维普
