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Şefoğlu ÖF, Yaka E, Pekdemir M, Yılmaz S, Özturan İU, Doğan NÖ. Comparison of Bedside Index for Severity in Acute Pancreatitis and Emergency Department SpO 2, Age and Systemic Inflammatory Response Syndrome Scores in Predicting Severe Acute Pancreatitis in Patients with Acute Pancreatitis in the Emergency Department. J Emerg Med 2024; 67:e10-e21. [PMID: 38806350 DOI: 10.1016/j.jemermed.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/12/2024] [Accepted: 03/06/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND As the mortality of severe acute pancreatitis (SAP) is significantly higher than those with mild or moderate severity, it is of clinical significance to identify patients most likely to develop SAP at the time of emergency department (ED) presentation. OBJECTIVES The aim of this study was to compare the performance of the Bedside Index for Severity in Acute Pancreatitis (BISAP) and the Emergency Department SpO2, Age and SIRS (ED-SAS) scoring systems as early risk assessment tools for identifying patients at high-risk of developing SAP. METHODS We retrospectively reviewed adult patients with AP presented to ED between January 2019-September 2022. We calculated the scores of each patient with the parameters of the initial data. The primary outcome was SAP. The secondary outcomes were 30-day mortality, intensive care admission, and identifying low-risk patients without complications. RESULTS Of 415 patients, 34 (8.2%) developed SAP and 15 (3.6%) died. With regard to predicting SAP, BISAP and ED-SAS scores had similar discriminative ability with area under the curves (AUCs) of 0.84 (95% confidence interval [CI]:0.80-0.88) and 0.83 (95% CI:0.79-0.86), respectively (p = 0.642). At a cut-off score of ≥2 for SAP, sensitivity/specificity values were 73.5%/82.4% for BISAP, 76.5%/83.2% for ED-SAS. BISAP and ED-SAS scores of ≥3, yielded sensitivity/specificity values of 50%/95.8% and 35.3%/95.5%, respectively. BISAP and ED-SAS were also similar in predicting mortality (AUCs of 0.92 vs. 0.90, respectively) and intensive care unit admission (AUCs 0.91 vs. 0.91). CONCLUSION The BISAP and ED-SAS scores performed similarly in predicting SAP, mortality, and intensive care unit admission. As an easily calculated tool early in the ED, ED-SAS may be helpful in disposition decisions for emergency physicians.
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Affiliation(s)
- Ömer Faruk Şefoğlu
- Department of Emergency Medicine, Arnavutkoy State Hospital, Istanbul, Turkey
| | - Elif Yaka
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey.
| | - Murat Pekdemir
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey
| | - Serkan Yılmaz
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey
| | - İbrahim Ulaş Özturan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey
| | - Nurettin Özgür Doğan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey
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Liu F, Yao J, Liu C, Shou S. Construction and validation of machine learning models for sepsis prediction in patients with acute pancreatitis. BMC Surg 2023; 23:267. [PMID: 37658375 PMCID: PMC10474758 DOI: 10.1186/s12893-023-02151-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/11/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND This study aimed to construct predictive models for the risk of sepsis in patients with Acute pancreatitis (AP) using machine learning methods and compared optimal one with the logistic regression (LR) model and scoring systems. METHODS In this retrospective cohort study, data were collected from the Medical Information Mart for Intensive Care III (MIMIC III) database between 2001 and 2012 and the MIMIC IV database between 2008 and 2019. Patients were randomly divided into training and test sets (8:2). The least absolute shrinkage and selection operator (LASSO) regression plus 5-fold cross-validation were used to screen and confirm the predictive factors. Based on the selected predictive factors, 6 machine learning models were constructed, including support vector machine (SVM), K-nearest neighbour (KNN), multi-layer perceptron (MLP), LR, gradient boosting decision tree (GBDT) and adaptive enhancement algorithm (AdaBoost). The models and scoring systems were evaluated and compared using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the area under the curve (AUC). RESULTS A total of 1, 672 patients were eligible for participation. In the training set, 261 AP patients (19.51%) were diagnosed with sepsis. The predictive factors for the risk of sepsis in AP patients included age, insurance, vasopressors, mechanical ventilation, Glasgow Coma Scale (GCS), heart rate, respiratory rate, temperature, SpO2, platelet, red blood cell distribution width (RDW), International Normalized Ratio (INR), and blood urea nitrogen (BUN). The AUC of the GBDT model for sepsis prediction in the AP patients in the testing set was 0.985. The GBDT model showed better performance in sepsis prediction than the LR, systemic inflammatory response syndrome (SIRS) score, bedside index for severity in acute pancreatitis (BISAP) score, sequential organ failure assessment (SOFA) score, quick-SOFA (qSOFA), and simplified acute physiology score II (SAPS II). CONCLUSION The present findings suggest that compared to the classical LR model and SOFA, qSOFA, SAPS II, SIRS, and BISAP scores, the machine learning model-GBDT model had a better performance in predicting sepsis in the AP patients, which is a useful tool for early identification of high-risk patients and timely clinical interventions.
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Affiliation(s)
- Fei Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, P.R. China
| | - Jie Yao
- Department of Anesthesiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, 075000, P.R. China
| | - Chunyan Liu
- Department of Intensive Care Unit, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, 075000, P.R. China
| | - Songtao Shou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, P.R. China.
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Shimizu A, Tsuguma Y, Sakata S, Ito M, Okada N, Asai W, Ushida K, Tameda M, Momosaki R. The Hospital Frailty Risk Score Predicts Poor Prognoses in Middle-Aged and Older Patients With Acute Pancreatitis: A Nationwide Retrospective Cohort Study in Japan. Pancreas 2023; 52:e249-e255. [PMID: 37747930 DOI: 10.1097/mpa.0000000000002246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVES Frailty risk may be associated with poor prognoses in acute pancreatitis patients. However, this has not been shown with adjustments for prognosis-related factors. This study aimed to determine whether frailty risk is associated with poor prognoses in acute pancreatitis patients, even after adjusting for prognosis-related factors. METHODS The study included 7001 middle-aged and older patients (mean age, 66.2 ± 14.5 years, 65.3% male) 40 years or older who were registered in a Japanese nationwide database. Frailty risk was defined as a Hospital Frailty Risk Score ≥5 points. Outcomes were 30-day and in-hospital mortality, length of stay, and 30-day readmission rate. RESULTS Frailty risk was independently positively associated with 30-day mortality (odds ratio [OR], 1.847; 95% confidence interval [CI], 1.118-3.051) and in-hospital mortality (OR, 2.504; 95% CI, 1.677-3.739) after adjustment for acute pancreatitis severity and patient characteristics. In addition, frailty risk was positively associated with a longer length of stay (coefficient, 11.393; 95% CI, 9.631-13.154). However, no association was found between frailty risk and the 30-day readmission rate (OR, 1.092; 95% CI, 0.793-1.504). CONCLUSIONS Our findings highlight the importance of rapid and automated frailty risk assessment using the Hospital Frailty Risk Score for the early identification of high-risk acute pancreatitis patients.
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Affiliation(s)
- Akio Shimizu
- From the Department of Food and Health Science, Faculty of Health and Human Sciences, Nagano Prefectural University, Nagano, Japan
| | - Yuma Tsuguma
- From the Department of Food and Health Science, Faculty of Health and Human Sciences, Nagano Prefectural University, Nagano, Japan
| | - Saya Sakata
- From the Department of Food and Health Science, Faculty of Health and Human Sciences, Nagano Prefectural University, Nagano, Japan
| | - Mako Ito
- From the Department of Food and Health Science, Faculty of Health and Human Sciences, Nagano Prefectural University, Nagano, Japan
| | - Natsumi Okada
- From the Department of Food and Health Science, Faculty of Health and Human Sciences, Nagano Prefectural University, Nagano, Japan
| | - Wakana Asai
- From the Department of Food and Health Science, Faculty of Health and Human Sciences, Nagano Prefectural University, Nagano, Japan
| | | | - Masahiko Tameda
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ryo Momosaki
- Department of Rehabilitation, Mie University Hospital
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Wang J, Xu X. Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. Am J Transl Res 2022; 14:3472-3480. [PMID: 35702086 PMCID: PMC9185021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine the effects of high-quality nursing on negative emotions, treatment compliance, and complications of peripherally inserted central catheter (PICC) placement in patients with leukemia. METHODS A total of 87 patients with leukemia treated in our hospital from May 2018 to May 2020 were retrospectively enrolled and their clinical data were analyzed. The patients were assigned to a routine group (n=40) and a high-quality group (n=47) based on different nursing schemes. The self-rating depression scale (SDS) and self-rating anxiety scale (SAS) were used to compare the negative emotional changes in patients of the two groups, and the visual analogue scale (VAS) was used to analyze the degree of pain. The two groups were compared in treatment compliance, quality of life, incidence of complications of PICC placement, and nursing satisfaction. RESULTS After intervention, the high-quality group got significantly lower SDS and SAS scores than the routine group (both P<0.05). Compared with the routine group, the high-quality group showed higher treatment compliance and nursing satisfaction, experienced higher quality of life (all P<0.05), with also a lower total incidence of complications of PICC placement (P<0.01). CONCLUSION For patients with leukemia, high-quality nursing can substantially improve their psychological state, treatment compliance and nursing satisfaction, and reduce the incidence of complications of PICC placement.
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Affiliation(s)
- Juan Wang
- Department of Hematology, The First Affiliated Hospital of Soochow University Suzhou 215006, Jiangsu, China
| | - Xiaoli Xu
- Department of Hematology, The First Affiliated Hospital of Soochow University Suzhou 215006, Jiangsu, China
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Formanchuk T, Shaprinskiy V, Formanchuk A. Clinical and simple laboratory data associated with fatal outcomes in patients with acute pancreatitis. ACTA FACULTATIS MEDICAE NAISSENSIS 2022. [DOI: 10.5937/afmnai39-32308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Aims. The aim of the study was to evaluate the association of mortality in acute pancreatitis with clinical and simple laboratory data received on the day of admission. Patients and methods. In our retrospective study, the clinical and laboratory parameters of 99 patients with moderate and severe acute pancreatitis were analyzed. All patients were divided into two groups: deceased and survivors. Results. We did not find a significant difference in age and gender distribution between the comparison groups. However, a significant predominance of alcoholic etiology of acute pancreatitis, early hospitalization (up to 6 hours from the onset of the disease) of patients, and the number of necrotizing infected type in the deceased group were found. Concomitant pathology did not significantly differ in comparison groups. In patients from the deceased group, the total number of all complications was significantly higher than in the group of survivors-21 (100%) and 42 (53.8%) (p = 0.0001), respecting. Among the laboratory parameters determined on the day of admission, in the deceased group, there was a significant increase in stabs to 19.8 ± 9.8 and ESR, AST to 225.3 ± 47.5 U/L, urea to 11.2 ± 7.7 mmol/L, and creatinine to 173.6 ± 26.1 mmol/L. Conclusion. The alcoholic genesis of acute pancreatitis, necrotizing infected type of inflammation of the pancreas, presence of late complications, and comorbidities were significantly higher in the deceased group. The levels of stabs, ESR, AST, urea, and creatinine determined on the admission significantly dominated in the deceased group, which requires further study for the prediction of mortality of acute pancreatitis.
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Glazer DI, Cochon LR, Raja AS, Jin DX, Banks PA, Sodickson AD, Khorasani R. Prevalence of imaging findings of acute pancreatitis in emergency department patients with elevated serum lipase. Am J Emerg Med 2021; 50:10-13. [PMID: 34271230 DOI: 10.1016/j.ajem.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To assess the association of imaging features of acute pancreatitis (AP) with the magnitude of lipase elevation in Emergency Department (ED) patients. METHODS This Institutional Review Board-approved retrospective study included 509 consecutive patients presenting from 9/1/13-8/31/15 to a large academic ED with serum lipase levels ≥3× the upper limit of normal (ULN) (≥180 U/L). Patients were excluded if they did not have imaging (n = 131) or had a history of trauma, abdominal metastases, altered mental status, or transfer from an outside hospital (n = 190); the final study population was 188 patients. Imaging exams were retrospectively evaluated, and a consensus opinion of two subspecialty-trained abdominal radiologists was used to diagnose AP. Primary outcome was presence of imaging features of AP stratified by lipase level (≥3×-10× ULN and > 10× ULN). Secondary outcome was rate of discordant consensus evaluation compared to original radiologist's report. RESULTS 25.0% of patients (47/188) had imaging features of AP. When lipase was >10× ULN (n = 94), patients were more likely to have imaging features of AP (34%) vs. those with mild elevation (16%) (p = 0.0042). There was moderately strong correlation between lipase level and presence of imaging features of AP (r = 0.48, p < 0.0001). Consensus review of CT and MRI images was discordant with the original report in 14.9% (28/188) of cases. CONCLUSION Prevalence of imaging signs of AP in an ED population with lipase ≥3× ULN undergoing imaging is low. However, the probability of imaging features of AP increases as lipase value increases.
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Affiliation(s)
- Daniel I Glazer
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America; Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America.
| | - Lailah R Cochon
- Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America
| | - Ali S Raja
- Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States of America
| | - David X Jin
- Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America
| | - Peter A Banks
- Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America
| | - Aaron D Sodickson
- Division of Emergency Radiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America
| | - Ramin Khorasani
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America; Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America
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Bruen C, Miller J, Wilburn J, Mackey C, Bollen TL, Stauderman K, Hebbar S. Auxora for the Treatment of Patients With Acute Pancreatitis and Accompanying Systemic Inflammatory Response Syndrome: Clinical Development of a Calcium Release-Activated Calcium Channel Inhibitor. Pancreas 2021; 50:537-543. [PMID: 33939666 PMCID: PMC8104014 DOI: 10.1097/mpa.0000000000001793] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/26/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess the safety of Auxora in patients with acute pancreatitis (AP), systemic inflammatory response syndrome (SIRS), and hypoxemia, and identify efficacy endpoints to prospectively test in future studies. METHODS This phase 2, open-label, dose-response study randomized patients with AP, accompanying SIRS, and hypoxemia (n = 21) to receive low-dose or high-dose Auxora plus standard of care (SOC) or SOC alone. All patients received pancreatic contrast-enhanced computed tomography scans at screenings, day 5/discharge, and as clinically required 90 days postrandomization; scans were blinded and centrally read to determine AP severity using computed tomography severity index. Solid food tolerance was assessed at every meal and SIRS every 12 hours. RESULTS The number of patients experiencing serious adverse events was not increased with Auxora versus SOC alone. Three (36.5%) patients with moderate AP receiving low-dose Auxora improved to mild AP; no computed tomography severity index improvements were observed with SOC. By study end, patients receiving Auxora better tolerated solid foods, had less persistent SIRS, and had reduced hospitalization versus SOC. CONCLUSIONS The favorable safety profile and patient outcomes suggest Auxora may be an appropriate early treatment for patients with AP and SIRS. Clinical development will continue in a randomized, controlled, blinded, dose-ranging study.
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Affiliation(s)
- Charles Bruen
- From the Departments of Critical Care Medicine
- Emergency Medicine, Regions Hospital, HealthPartners, St. Paul, MN
| | - Joseph Miller
- Departments of Emergency Medicine
- Internal Medicine, Henry Ford Hospital System
| | - John Wilburn
- Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Caleb Mackey
- Departments ofPulmonary Medicine
- Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH
| | - Thomas L. Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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