Nomogram for the prediction of in-hospital incidence of acute respiratory distress syndrome in patients with acute pancreatitis

Abstract

Objective: The aim of this study was to formulate and validate an individualized predictive nomogram for in-hospital incidence of acute respiratory distress syndrome (ARDS) in patients with acute pancreatitis(AP). Design: AP patients were randomly distributed into primary cohort and validation cohort. Based on the primary cohort, risk factors were identified by logistic regression model and a nomogram was performed. The nomogram was validated in the primary and validation cohort by the bootstrap validation method. The calibration curve was applied to evaluate the consistency between nomogram and ideal observation. Setting: Departments of Emergency Medicine of two university-affiliated tertiary hospitals. Participants: From January 2017 to December 2018, 779 individuals with AP were included in this study. Primary outcome measures: The in-hospital incidence of ARDS was assessed. Results: There were 728 patients in the non-ARDS group and 51patients in the ARDS group, with an incidence rate of about 6.55%. Five independent factors including white blood counts(WBC),prothrombin time(PT),albumin(ALB),serum creatinine(SCR)and triglyceride (TG) were associated with in-hospital incidence of ARDS in AP patients. A nomogram was constructed based on the five independent factors with primary cohort of AUC 0.821 and validation cohort of AUC 0.822. Calibration curve analysis indicated that the predicted probability was in accordance with the observed probability in both primary and validation cohorts. Conclusions: The study developed an intuitive nomogram with easily available laboratory parameters for the prediction of in-hospital incidence of ARDS in patients with AP. The incidence of ARDS for an individual patient can be fast and conveniently evaluated by our nomogram.

A prediction model for acute respiratory distress syndrome among patients with severe acute pancreatitis: a retrospective analysis

“…19–22 In pneumonia-caused ARDS, increasing age and comorbidities were associated with high risk of developing ARDS. Surprisingly, there were no statistically significant differences in age and comorbidities among SAP patients with or without ARDS in the present study, which was consistent with previous studies among patients with SAP 23,24 and AP, 16,25 indicating that age and comorbidities is not as much of a risk factor in SAP-related ARDS as in pneumonia-initiated ARDS. Although hypertriglyceridemia-induced AP has been reported to be associated with risk of lung failure compared with other etiologies, 16,26 the etiologies of SAP have no significant differences between the groups with or without ARDS.…”

“…38 Furthermore, LDH, creatinine, and procalcitonin were reported to be independent factors associated with the severity of SAP, which had more likelihood of inducing the comorbidity of ARDS. 14,16,39…”

“…Each cutoff values were set as the upper or lower limit of normal value or clinical cutoff based on clinical significance or previous studies. 9–18 Univariate analysis was performed to assess differences in the characteristics of patients with and without ARDS. Finally, variables with an overall p < .1 in the univariate analysis were included in a multivariate stepwise logistic regression model to assess the early predictive models of ARDS in patients with SAP.…”

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.…”