A Clinical and Imaging-based Model for Distinguishing Mild From Moderately Severe/Severe Hypertriglyceridemic Acute Pancreatitis: Development and Validation.

Background: Hypertriglyceridemic acute pancreatitis (HTG-AP) is a distinct subtype of acute pancreatitis with a wide spectrum of clinical severity, ranging from mild to moderately severe or severe disease. Timely identification of patients at higher risk is essential for informing early clinical decisions and improving outcomes. However, reliable tools specifically designed to stratify HTG-AP severity remain limited.

Objective: To develop and validate a predictive model for distinguishing mild from moderately severe/severe hypertriglyceridemic acute pancreatitis (HTG-AP) using routine clinical and imaging parameters.

Methods: This retrospective study included 106 patients diagnosed with HTG-AP at Guangzhou First People's Hospital from January 2018 to April 2023. Patients were categorized into mild (HTG-MAP) and moderately severe/severe (HTG-MSAP/SAP) groups based on the revised Atlanta classification. Clinical data, laboratory results, and imaging findings, including peak C-reactive protein (CRP), serum calcium levels, and Modified CT Severity Index (MCTSI) scores, were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of disease severity. Model performance was assessed through 10-fold cross-validation and bootstrap calibration.

Results: Among the 106 patients (median age: 38 y; 82.1% male), 46 had HTG-MAP and 60 had HTG-MSAP/SAP. Multivariate analysis identified peak CRP (OR: 1.0082, P=0.011), serum calcium (OR: 0.05, P=0.014), and MCTSI score ≥6 (OR: 4.91, P=0.008) as independent predictors of severe disease. The final logistic regression model demonstrated excellent discrimination, with an AUC of 0.900 in the overall cohort and a mean cross-validated AUC of 0.87. Calibration was satisfactory (Hosmer-Lemeshow P=0.774), and overall diagnostic accuracy reached 84.91%.

Conclusions: The proposed model, incorporating peak CRP, serum calcium, and MCTSI score, effectively distinguishes between HTG-MAP and HTG-MSAP/SAP. Compared with conventional scoring systems such as Bedside Index for Severity in Acute Pancreatitis (BISAP), it demonstrates superior specificity and overall diagnostic accuracy, providing clinicians with a practical tool for risk stratification and clinical decision-making in HTG-AP.