A Novel Risk-Prediction Scoring System for Sepsis among Patients with Acute Pancreatitis: A Retrospective Analysis of a Large Clinical Database

Abstract

Background. The prognosis is poor when acute pancreatitis (AP) progresses to sepsis; therefore, it is necessary to accurately predict the probability of sepsis and develop a personalized treatment plan to reduce the disease burden of AP patients. Methods. A total of 1295 patients with AP and 43 variables were extracted from the Medical Information Mart for Intensive Care (MIMIC) IV database. The included patients were randomly assigned to the training set and to the validation set at a ratio of 7 : 3. The chi-square test or Fisher’s exact test was used to test the distribution of categorical variables, and Student’s t-test was used for continuous variables. Multivariate logistic regression was used to establish a prognostic model for predicting the occurrence of sepsis in AP patients. The indicators to verify the overall performance of the model included the area under the receiver operating characteristic curve (AUC), calibration curves, the net reclassification improvement (NRI), the integrated discrimination improvement (IDI), and a decision curve analysis (DCA). Results. The multifactor analysis results showed that temperature, phosphate, calcium, lactate, the mean blood pressure (MBP), urinary output, Glasgow Coma Scale (GCS), Charlson Comorbidity Index (CCI), sodium, platelet count, and albumin were independent risk factors. All of the indicators proved that the prediction performance and clinical profitability of the newly established nomogram were better than those of other common indicators (including SIRS, BISAP, SOFA, and qSOFA). Conclusions. The new risk-prediction system that was established in this research can accurately predict the probability of sepsis in patients with acute pancreatitis, and this helps clinicians formulate personalized treatment plans for patients. The new model can reduce the disease burden of patients and can contribute to the reasonable allocation of medical resources, which is significant for tertiary prevention.

Correlative factor of death in patients with infected pancreatic necrosis after surgical intervention

“…In addition, it was previously proved that sepsis (positive blood culture) was a cause of death, as it could result in shock (usually needs vasoactive drugs) and organ dysfunction. [14–17] In addition, the results of the present study suggested that A baumannii infection was also a risk factor for death in patients with infected pancreatic necrosis after surgical intervention. A baumannii has become the main source of nosocomial infection, especially in intensive care unit.…”

Association between serum creatinine to albumin ratio and short- and long-term all-cause mortality in patients with acute pancreatitis admitted to the intensive care unit: a retrospective analysis based on the MIMIC-IV database

“…For example, the SOFA score mainly focuses on the function of multiple organ systems and does not specifically address the pathological and physiological characteristics of pancreatitis itself, thus may lack sensitivity or specificity ( 4 , 10 ). Similarly, although the GCS score and SIRS score reflect the patient’s level of consciousness and systemic inflammatory response, they may not fully consider the specific conditions of pancreatic tissue damage and inflammation in the prognosis assessment of pancreatitis ( 44 , 45 ). CAR takes Cr and Alb levels into account and reflects a combination of renal function and nutritional status.…”

Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence

“…In a retrospective analysis encompassing a total of 1295 AP patients, Feng et al [ 149 ] developed an independent predictive tool, known as a nomogram, to predict the likelihood of sepsis occurrence in this patient population. In this study, the predictive performance and clinical utility of the newly established nomogram surpassed those of other scoring systems such as SIRS, BISAP, SOFA, and qSOFA[ 149 ]. The innovative risk-prediction system could precisely estimate the likelihood of sepsis in AP patients, assisting clinicians in formulating personalized treatment strategies for the patients.…”

“…The innovative risk-prediction system could precisely estimate the likelihood of sepsis in AP patients, assisting clinicians in formulating personalized treatment strategies for the patients. By doing so, it not only alleviated the disease burden of the patients but also facilitated the reasonable distribution of medical resources, which was a crucial aspect of tertiary prevention[ 149 ]. The nomogram incorporated all the independent prognostic factors, including body temperature, phosphate, Ca 2+ , sodium, lactate, albumin, platelet count, urinary output, mean blood pressure, Glasgow Coma Scale, and Charlson Comorbidity Index[ 149 ].…”

“…By doing so, it not only alleviated the disease burden of the patients but also facilitated the reasonable distribution of medical resources, which was a crucial aspect of tertiary prevention[ 149 ]. The nomogram incorporated all the independent prognostic factors, including body temperature, phosphate, Ca 2+ , sodium, lactate, albumin, platelet count, urinary output, mean blood pressure, Glasgow Coma Scale, and Charlson Comorbidity Index[ 149 ]. These diverse elements collectively contributed to its predictive strength.…”