ObjectiveTo analyze the clinical characteristics of acute pancreatitis (AP) complicated with pulmonary infection and to explore the value of BISAP, APACHEⅡ and CTSI scores combined with C-reactive protein (CRP) in early diagnosis and prognosis of AP complicated with pulmonary infection.MethodsFour hundreds and eighty-four cases of AP treated in the Affiliated Hospital of North Sichuan Medical College from January 2018 to January 2020 were selected. After screening, 460 cases were included as the study object, and the patients with pulmonary infection were classified as the infection group (n=114). Those without pulmonary infection were classified as the control group (n=346). The baseline data, clinical characteristics, laboratory test indexes, length of stay, hospitalization cost, and outcome of the two groups were collected, and the risk factors and early predictive indexes of pulmonary infection in patients with AP were analyzed.ResultsHospitalization days and expenses, outcome, fluid replacement within 24 hours, drinking, smoking, age, APACHEⅡ score, BISAP score, CTSI score, hemoglobin (Hb), albumin (ALB), CRP, procalcitonin (PCT), total bilirubin (TB), lymphocyte count, international standardized ratio (INR), blood glucose, and blood calcium, there were significant differences between the two groups (P<0.05). There were no significant difference in BMI, sex, recurrence rate, fatty liver grade, proportion of patients with hypertension and diabetes between the two groups (P>0.05). The significant indexes of univariate analysis were included in multivariate regression analysis, the results showed that Hb≤120 g/L, CRP≥56 mg/L, PCT≥1.65 ng/mL, serum calcium≤2.01 mmol/L, BISAP score≥3, APACHEⅡ score≥8, CTSI score≥3, and drinking alcohol were independent risk factors of AP complicated with pulmonary infection. The working characteristic curve of the subjects showed that the area under the curve (AUC) of CRP, BISAP score, APACHEⅡ score and CTSI score were 0.846, 0.856, 0.882, 0.783, respectively, and the AUC of the four combined tests was 0.952. The AUC of the four combined tests was significantly higher than that of each single test (P<0.05).Conclusions The CRP level, Apache Ⅱ score, bisap score and CTSI score of AP patients with pulmonary infection are significantly higher, which are closely related to the severity and prognosis of AP patients with pulmonary infection. The combined detection of the four items has more predictive value than the single detection in the early diagnosis and prognosis evaluation of AP complicated with pulmonary infection. Its application in clinic is of great significance to shorten the duration of hospitalization and reduce the cost of hospitalization and mortality.
ObjectiveTo investigate predictive value of a new blood biochemical scoring system (CPWAG scoring system) on severity and mortality of acute pancreatitis (AP).MethodsThe AP patients who met the inclusion and exclusion criteria in our hospital from January 2017 to June 2019 were collected, then were divided into severe acute pancreatitis (SAP) group and non-SAP group according to the latest Atlanta classification. The differences of clinical characteristics and related blood biochemical indicators between the SAP group and the non-SAP group were compared. Univariate logistic regression analysis was used to screen blood biochemical risk indicators related to SAP. The receiver operating characteristic (ROC) curve was used to obtain the best cut-off value corresponding to the maximum Youden index of statistical significant risk factors and was assigned as 0 or 1 point according to different situations. At the same time, the pleural effusion of the BISAP score was included and assigned as 0 (yes) or 1 (no) point, then the CPWAG score was obtained by adding the point of the above indexes.The areas under the ROC curve (AUC) of the CPWAG, BISAP, APACHEⅡ, CTSI, and Ranson scoring systems in predicting severity and death of AP patients were also compared.ResultsA total of 451 patients with AP were included in this study, including 85 patients with SAP and 366 patients with non-SAP. Compared with the non-SAP group, the etiology of AP was mainly biliary (P<0.05), with higher levels of white blood cell count (WBC), C reactive protein (CRP), procalcitonin (PCT), and glucose (P<0.05), greater red blood cell distribution width value (P<0.05), longer prothrombin time (PT) and hospital stay (P<0.05), lower albumin (ALB) and blood calcium levels (P<0.05), higher BISAP, APACHEⅡ, CTSI and Ranson points (P<0.05), and higher proportions of patients with pleural effusion, multiple organ dysfunction syndrome, and death (P<0.05) in the SAP group. The highest score of the CPWAG scoring system included CRP, PCT, WBC, ALB, glucose, blood calcium, and pleural effusion was 7. With the increase of CPWAG score, the proportion of SAP and death patients showed an increasing trend (P<0.001). The AUC of the CPWAG scoring system in predicting SAP was 0.866, which was higher than those of Ranson (AUC=0.722, Z=5.317, P<0.001), APACHEⅡ (AUC=0.706, Z=5.019, P<0.001), and CTSI (AUC=0.805, Z=1.962, P=0.005) scoring system, but which had no statistically significant difference as compared with the BISAP scoring system (AUC=0.819, Z=1.816, P=0.070). The AUC of the CPWAG scoring system in predicting death had a high ability (AUC=0.823), which had no significant differences as compared with the Ranson, APACHEⅡ, CTSI, and BISAP scoring systems (P>0.05).ConclusionThe CPWAG score is valuable in predicting the severity and mortality of AP patients, allowing accurate and early assessment of AP patients.
Objective To establish a predictive model for long-term tumor-specific survival after surgery for patients with intermediate to advanced medullary thyroid cancer (MTC) based on American Joint Committee on Cancer (AJCC) TNM staging, by using the Surveillance, Epidemiology, and End Results (SEER) Database. Methods The data of 692 patients with intermediate to advanced MTC who underwent total thyroidectomy and cervical lymph node dissection registered in the SEER database during 2004–2017 were extracted and screened, and were randomly divided into 484 cases in the modeling group and 208 cases in the validation group according to 7∶3. Cox proportional hazard regression was used to screen predictors of tumor-specific survival after surgery for intermediate to advanced stage MTC and to develop a Nomogram model. The accuracy and usefulness of the model were tested by using the consistency index (C-index), calibration curve, time-dependent ROC curve and decision curve analysis (DSA). Results In the modeling group, the multivariate Cox proportional hazard regression model indicated that the factors affecting tumor-specific survival after surgery in patients with intermediate to advanced MTC were AJCC TNM staging, age, lymph node ratio (LNR), and tumor diameter, and the Nomogram model was developed based on these results. The modeling group had a C-index of 0.827 and its area under the 5-year and 10-year time-dependent ROC curves were 0.865 [95%CI (0.817, 0.913)], 0.845 [95%CI (0.787, 0.904)], respectively, and the validation group had a C-index of 0.866 and its area under the 5-year and 10-year time-dependent ROC curves were 0.866 [95%CI (0.798, 0.935)] and 0.923 [95%CI (0.863, 0.983)], respectively. Good agreement between the model-predicted 5- and 10-year tumor-specific survival rates and the actual 5- and 10-year tumor-specific survival rates were showed in both the modeling and validation groups. Based on the DCA curve, the new model based on AJCC TNM staging was developed with a significant advantage over the former model containing only AJCC TNM staging in terms of net benefits obtained by patients at 5 years and 10 years after surgery. Conclusion The prognostic model based on AJCC TNM staging for predicting tumor-specific survival after surgery for intermediate to advanced MTC established in this study has good predictive effect and practicality, which can help guide personalized, precise and comprehensive treatment decisions and can be used in clinical practice.