比较和评估 BISAP 和兰森评分系统等早期预测指标与改良 CT 严重程度指数在评估急性胰腺炎严重程度中的作用

IF 0.4 4区 医学 Q4 SURGERY
Raghav Gupta, Shyam Kumar Gupta
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引用次数: 0

摘要

急性胰腺炎是一种以胰腺急性坏死性炎症变化为特征的疾病,组织学上以胰腺尖细胞破坏为特征。它是因腹痛住院的最常见原因之一。目前已提出几种分类系统来评估急性胰腺炎的严重程度和预后。Ranson 和急性胰腺炎床旁严重程度指数(BISAP)等评分可用于评估疾病的严重程度和死亡率。修订后的亚特兰大分类法主要侧重于形态学标准,主要通过 CT 和 MRI 来定义急性胰腺炎的各种表现。查谟政府医学院外科系进行了一项病例系列分析研究,其中包括 57 名急性胰腺炎患者。研究人员使用事先准备好的表格计算并比较了 BISAP 评分、Ranson 评分和改良 CT 严重性指数(mCTSI)。在接受 CT 扫描的患者中评估了 BISAP 和 Ranson 评分系统的灵敏度、特异性和曲线下面积 (AUC),并将 mCTSI 作为参考标准。研究对象的平均年龄为 46.49 岁(标准差 14.11),其中男性 14 人(24.56%),女性 43 人(75.44%)。男女比例为 0.32。在结石性病因中,胆石症是急性胰腺炎最常见的病因,有 35 例(61.40%)患者患病,其次是特发性急性胰腺炎。在 57 名患者中,40 名患者接受了 CT 扫描。在这 40 名患者中,31 人(77.5%)根据 BISAP 评分(BISAP 评分≥2 分)被归类为重症,33 人(82.5%)根据 Ranson 评分系统(Ranson 评分≥3 分)被归类为重症。BISAP 的灵敏度和特异性分别为 90.90% 和 85.71%。兰森的敏感性和特异性分别为 93.93% 和 71.42%。与 BISAP 相比,Ranson 的灵敏度更高,但特异性更低。在我们的研究中,BISAP 的曲线下面积(AUC)为 0.70,而 Ranson 的曲线下面积(AUC)为 0.94。根据曲线下面积(AUC),Ranson 评分在预测重症急性胰腺炎方面比 BISAP 更准确。BISAP 评分在预测急性胰腺炎严重程度方面与 Ranson 评分不相上下,P 值(P = 0.089)在统计学上不显著。急性胰腺炎床旁严重程度指数(BISAP)提供了一种直接而及时的方法,可在发病 24 小时内识别严重病例。相反,Ranson 评分在确定有重症急性胰腺炎和随后器官衰竭风险的患者方面仍有其价值。在我们的研究中,P 值为 > 0.05,这表明 BISAP 和 Ranson 评分在评估急性胰腺炎严重程度方面具有相同的能力,可作为早期干预患者的可靠预后工具。然而,与 BISAP 相比,Ranson 评分具有更高的灵敏度和特异性,这加强了其在临床实践中的实用性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Comparing and Evaluating the Role of Early Predictors Like BISAP and Ranson Scoring System with Modified CT Severity Index in Assessing the Severity of Acute Pancreatitis

Comparing and Evaluating the Role of Early Predictors Like BISAP and Ranson Scoring System with Modified CT Severity Index in Assessing the Severity of Acute Pancreatitis

Acute pancreatitis is a disorder characterized by acute necro-inflammatory changes of the pancreas and histologically marked by acinar cell destruction. It is one of the most common causes of hospitalization due to abdominal pain. Several classification systems have been proposed to assess the severity and prognosis of acute pancreatitis. Scores such as the Ranson and bedside index for severity in acute pancreatitis (BISAP) are useful for evaluating the severity and mortality of the disease. The revised Atlanta classification mainly focuses on the morphologic criteria for defining the various manifestations of acute pancreatitis outlined principally by means of CT and MRI. A case-series analysis study was conducted under the Department of Surgery, Government Medical College, Jammu, including 57 patients who presented with acute pancreatitis. The BISAP scores, along with Ranson scores and modified CT severity index scores (mCTSI), were calculated and compared using a preformed performa. The sensitivity, specificity, and area under the curve (AUC) of the BISAP and Ranson’s scoring systems were evaluated in patients who received CT scans, with mCTSI serving as the reference standard. The mean age of the study population was 46.49 years SD 14.11 with 14 (24.56%) men and 43 (75.44%) women. The men to women ratio was 0.32. Among the calculous etiology, cholelithiasis was the most common cause of acute pancreatitis, affecting 35 (61.40%) patients, followed by idiopathic acute pancreatitis. Out of 57 patients, 40 patients underwent CT scanning. Out of these 40 patients, 31 (77.5%) were classified as severe according to BISAP score with a cutoff of BISAP score ≥ 2, and 33 (82.5%) were classified as severe according to Ranson scoring system, with a cutoff of Ranson score ≥ 3. The sensitivity and specificity of BISAP were 90.90% and 85.71%, respectively. The sensitivity and specificity of Ranson were 93.93% and 71.42%, respectively. Ranson was more sensitive but less specific than BISAP. In our study, area under curve (AUC) of BISAP was 0.70, and area under curve (AUC) of Ranson was 0.94. Ranson scoring was more accurate than BISAP in predicting severe acute pancreatitis, according to area under curve (AUC). BISAP scoring is comparable to the Ranson score in predicting the severity of acute pancreatitis, with statistically insignificant p-value (p = 0.089). The bedside index for severity in acute pancreatitis (BISAP) offers a straightforward and timely means of identifying severe cases within 24 h of disease onset. Conversely, Ranson’s score retains its value in pinpointing patients at risk of severe acute pancreatitis and ensuing organ failure. In our study, p-value is > 0.05, which indicates that both BISAP and Ranson’s score are equally adept at assessing acute pancreatitis severity, serving as reliable prognostic tools for early patient intervention. However, Ranson’s score boasts superior sensitivity and specificity compared to BISAP, reinforcing its utility in clinical practice.

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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
412
审稿时长
6-12 weeks
期刊介绍: The Indian Journal of Surgery is the official publication of the Association of Surgeons of India that considers for publication articles in all fields of surgery. Issues are published bimonthly in the months of February, April, June, August, October and December. The journal publishes Original article, Point of technique, Review article, Case report, Letter to editor, Teachers and surgeons from the past - A short (up to 500 words) bio sketch of a revered teacher or surgeon whom you hold in esteem and Images in surgery, surgical pathology, and surgical radiology. A trusted resource for peer-reviewed coverage of all types of surgery Provides a forum for surgeons in India and abroad to exchange ideas and advance the art of surgery The official publication of the Association of Surgeons of India 92% of authors who answered a survey reported that they would definitely publish or probably publish in the journal again The Indian Journal of Surgery offers peer-reviewed coverage of all types of surgery. The Journal publishes Original articles, Points of technique, Review articles, Case reports, Letters, Images and brief biographies of influential teachers and surgeons. The Journal spans General Surgery, Pediatric Surgery, Neurosurgery, Plastic Surgery, Cardiothoracic Surgery, Vascular Surgery, Rural Surgery, Orthopedic Surgery, Urology, Surgical Oncology, Radiology, Anaesthesia, Trauma Services, Minimal Access Surgery, Endocrine Surgery, GI Surgery, ENT, Colorectal Surgery, surgical practice and research. The Journal provides a forum for surgeons from India and abroad to exchange ideas, to propagate the advancement of science and the art of surgery and to promote friendship among surgeons in India and abroad. This has been a trusted platform for surgons in communicating up-to-date scientific informeation to the community.
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