A novel nomogram for predicting survival in patients with severe acute pancreatitis: an analysis based on the large MIMIC-III clinical database

Abstract

Background Severe acute pancreatitis (SAP) can cause various complications. Septic shock is a relatively common and serious complication that causes uncontrolled systemic inflammatory response syndrome, which is one of the main causes of death. This study aimed to develop a nomogram for predicting the overall survival of SAP patients during the initial 24 hours following admission. Materials and Methods All data utilized in this study were obtained from the MIMIC-III (Medical Information Mart for Intensive Care III) database. The data were analyzed using multivariate Cox regression, and the performance of the proposed nomogram was evaluated based on Harrell’s concordance index (C-index) and the area under the receiver operating characteristic curve(AUC). The clinical value of the prediction model was tested using decision-curve analysis (DCA). The primary outcomes were 28-day,60-day, and 90-day mortality rates. Results The 850 patients included in the analysis comprised 595 in the training cohort and 255 in the validation cohort. The training cohort consisted of 353 (59.3%) males and 242 (40.7%) females with SAP. Multivariate Cox regression showed that weight, sex, insurance status, explicit sepsis, SAPSII score, Elixhauser score, bilirubin, anion gap, creatinine, hematocrit, hemoglobin, RDW, SpO 2 , and respiratory rate were independent prognostic factors for the survival of SAP patients admitted to an intensive care unit. The predicted values were compared using C-indexes, calibration plots, integrated discrimination improvement, net reclassification improvement, and DCA. Conclusions We have identified some important demographic and laboratory parameters related to the prognosis of patients with SAP, and have used them to establish a more accurate and convenient nomogram for evaluating their 28-day, 60-day, and 90-day all-cause mortality rates. The prognostic value of the novel nomogram is superior to that of the traditional SAPSII scoring system alone.

Prediction of acute pancreatitis complications using routine blood parameters during early admission

“…Most AP patients have a mild course of disease, but nearly 20% of patients can experience complications, and those with complications have a mortality rate as high as 60%. 7,16,17 Most complications cannot be treated by specific drugs; some require surgical intervention, such as endoscopic surgery, and are prone to recurrence after surgery, which adversely affects the quality of life of patients, increasing the economic and psychological burden. Therefore, early prediction of the possible complications in AP patients and early intervention can improve their condition and prognosis.…”

“…AP is an inflammatory process of the pancreatic gland, accompanied by the release of large amounts of amylase and lipase into the blood circulation, often leading to local and systemic complications, and can lead to multiple organ failure and death. Most AP patients have a mild course of disease, but nearly 20% of patients can experience complications, and those with complications have a mortality rate as high as 60% 7,16,17 . Most complications cannot be treated by specific drugs; some require surgical intervention, such as endoscopic surgery, and are prone to recurrence after surgery, which adversely affects the quality of life of patients, increasing the economic and psychological burden.…”

A Novel Nomogram for Predicting Survival in Patients with Severe Acute Pancreatitis: An Analysis Based on the Large MIMIC-III Clinical Database

“…Finally, because the data in the MIMIC-III database are relatively old, the database could only be used for internal validation. erefore, in future research we need to conduct external verification based on our own data to further verify the performance and accuracy of the new nomogram [46].…”

“…is manuscript is available in a preprint version (https:// www.Researchsquare.com/article/rs-135817/v1) [46]. e authors have completed the Observational Studies in Epidemiology Reporting checklist.…”