Establishment and application of an early predictive model for mortality of moderately of severe acute pancreatitis and severe acute pancreatitis in elderly patients

Objective To investigate the risk factors of death and to establish an early multi-index predictive model for mortality moderately of severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) in elderly patients. Methods Clinical data of 58 eligible elderly patients of MSAP and SAP between January 2014 and May 2017 in First Affiliated Hospital of Harbin Medical University were analyzed retrospectively, including 18 cases (31.0%) in the death group and 40 cases in the control group (69.0%). Univariate analysis and logistic regression analysis were used to screen out the independent risk factors related to death, combined with these independent risk factors, the unweighted predictive model (unwScore) and weighted predictive model (wScore) for mortality were established. The receiver-operating characteristic (ROC) curves of independent risk factors and predictive models were drawn to determine the cut-off value, to calculate the area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value and to observe the clinical predictive effectiveness. Student′s t-test was used to analyze continuous variables that complied with a normal distribution expressed as (±s). Mann-Whitney U test was used to analyze abnormally distributed variables expressed as median (quartile range) [M(P25, P75)]. chi-square test or Fisher′s exact test was used to analyze categorical data expressed by rate (%). Univariate analysis was used to screen out data with statistically significant difference, and then Logistic regression analysis was performed to determine independent predictors. Results Univariate analysis showed that there were statistically significant differences in pro-calcitonin, serum albumin (ALB), serum calcium, D-dimers, mean arterial pressure, pleural effusion and peritoneal effusion between the two groups (P<0.05); multivariate analysis showed that ALB, pleural effusion and peritoneal effusion were independent risk factors for mortality of MSAP, SAP in early patients, which AUC were 0.815, 0.678, 0.696, sensitivity were 0.611, 0.556, 0.667, specificity were 0.825, 0.800, 0.725, the positive predictive values were 61.1%, 55.6%, 52.2%, and the negative predictive values were 82.5%, 80.0%, 89.9%, respectively. The AUC of unwScore and wScore were 0.852 and 0.863, the sensitivity were 0.667 and 0.778, the specificity were 0.875 and 0.800, the positive predictive values were 70.6% and 63.6%, and the negative predictive values were 85.4% and 88.9%, respectively. Conclusion ALB, pleural effusion and peritoneal effusion were independent risk factors for mortality of MSAP, SAP in elderly patients. The multi-index predictive model had good clinical predictive effectiveness, which could provide clinical references for the treatment of MSAP and SAP in elderly patients. Key words: Pancreatitis; Aged; Risk factors; Mortality