A nomogram for predicting the risk of mortality in patients with acute pancreatitis and Gram-negative bacilli infection

Abstract

ObjectiveGram-negative bacilli (GNB) are common pathogens of infection in severe acute pancreatitis (SAP), and their occurrence increases the mortality of SAP. Early identification of SAP severity and prognosis is of great significance to SAP treatment. This study explored risk factors for mortality in patients with SAP and GNB infection and established a model for early prediction of the risk of death in GNB-infected SAP patients.MethodsPatients diagnosed with SAP from January 1, 2016, to March 31, 2022, were included, and their baseline clinical characteristics were collected. Univariate logistic regression analysis was performed to screen for death related variables, and concurrently, a Boruta analysis was performed to identify potentially important clinical features associated with mortality. The intersection of the two results was taken for further multivariate logistic regression analysis. A logistic regression model was constructed according to the independent risk factor of death and then visualized with a nomogram. The performance of the model was further validated in the training and validation cohort.ResultsA total of 151 patients with SAP developed GNB infections. Univariate logistic regression analysis identified 11 variables associated with mortality. The Boruta analysis identified 11 clinical features, and 4 out of 9 clinical variables: platelet counts (odds ratio [OR] 0.99, 95% confidence interval [CI] 0.99–1.00; p = 0.007), hemoglobin (OR 0.96, 95% CI 0.92–1; p = 0.037), septic shock (OR 6.33, 95% CI 1.12–43.47; p = 0.044), and carbapenem resistance (OR 7.99, 95% CI 1.66–52.37; p = 0.016), shared by both analyses were further selected as independent risk factors by multivariate logistic regression analysis. A nomogram was used to visualize the model. The model demonstrated good performance in both training and validation cohorts with recognition sensitivity and specificity of 96% and 80% in the training cohort and 92.8% and 75% in the validation cohort, respectively.ConclusionThe nomogram can accurately predict the mortality risk of patients with SAP and GNB infection. The clinical application of this model allows early identification of the severity and prognosis for patients with SAP and GNB infection and identification of patients requiring urgent management thus allowing rationalization of treatment options and improvements in clinical outcomes.

Acute Pancreatitis—Drivers of Hospitalisation Cost—A Seven-Year Retrospective Study from a Large Tertiary Center

“…We did not find data that assessed AP cost by stratification regarding discharge outcomes. However, these results were in congruence with what we had expected, as the great drivers for mortality in AP-such as systemic inflammatory response syndrome, shock [15,16], multiple organ failure (respiratory, cardiovascular, or renal) [17], and infections [18]-require more investigations, more expensive molecules and/or more procedures to treat. We believe that the high cost of the deceased cases was driven not only by frailty but also a higher rate of comorbidity of those cases, as one of the limitations of our study was not accounting for those, as well as by the higher efforts undertaken by their case physician to limit the evolution of the disease.…”

Carbapenem-resistant gram-negative bacterial infection in intensive care unit patients: Antibiotic resistance analysis and predictive model development

“…However, they did not investigate the different strains of CR-GNB nor validate their findings. Yan et al constructed a model for the early prediction of death risk in severe acute pancreatitis patients infected with GNB (Yan et al, 2022). They found that platelets, hemoglobin, septic shock and carbapenem resistance were independent risk factors for mortality in these patients, based on which they proposed a nomogram for predicting the risk of mortality.…”

Establishment and Validation of an Early Predictive Model for Severe Acute Pancreatitis

“…The diagnosis of AP needs to meet two of the following three characteristics: (1) gastrointestinal symptoms related to AP, such as abdominal pain, bloating, vomiting, etc. ; (2) The activity of serum amylase or lipase is at least three times higher than the normal upper limit; (3) CT enhanced scanning, MRI, or transabdominal ultrasound display the characteristic features of AP. 13 SAP is defined that AP is accompanied by organ dysfunction, lasting for more than 48 hours.…”

“…About 20% of patients will develop severe acute pancreatitis (SAP), which has a high mortality rate, poor prognosis, and a mortality rate of up to 30% to 50%. 2,3 A retrospective study in southern Israel showed that between 2000 and 2012, 602 out of approximately 500,000 hospitalized patients were diagnosed with AP. 4 In France, there are approximately 15,000 cases of AP per year.…”