A Novel Risk-Prediction Scoring System for Sepsis among Patients with Acute Pancreatitis: A Retrospective Analysis of a Large Clinical Database

Abstract

Background: The prognosis is poor when acute pancreatitis (AP) progresses to sepsis; therefore, it is necessary to accurately predict the probability of sepsis and develop a personalized treatment plan to reduce the disease burden of AP patients.

Methods: A total of 1295 patients with AP and 43 variables were extracted from the Medical Information Mart for Intensive Care (MIMIC) IV database. The included patients were randomly assigned to the training set and to the validation set at a ratio of 7 : 3. The chi-square test or Fisher's exact test was used to test the distribution of categorical variables, and Student's t-test was used for continuous variables. Multivariate logistic regression was used to establish a prognostic model for predicting the occurrence of sepsis in AP patients. The indicators to verify the overall performance of the model included the area under the receiver operating characteristic curve (AUC), calibration curves, the net reclassification improvement (NRI), the integrated discrimination improvement (IDI), and a decision curve analysis (DCA).

Results: The multifactor analysis results showed that temperature, phosphate, calcium, lactate, the mean blood pressure (MBP), urinary output, Glasgow Coma Scale (GCS), Charlson Comorbidity Index (CCI), sodium, platelet count, and albumin were independent risk factors. All of the indicators proved that the prediction performance and clinical profitability of the newly established nomogram were better than those of other common indicators (including SIRS, BISAP, SOFA, and qSOFA).

Conclusions: The new risk-prediction system that was established in this research can accurately predict the probability of sepsis in patients with acute pancreatitis, and this helps clinicians formulate personalized treatment plans for patients. The new model can reduce the disease burden of patients and can contribute to the reasonable allocation of medical resources, which is significant for tertiary prevention.

Figure 1

Flowchart of study cohort selection.

Figure 2

Nomogram for predicting occurrence of sepsis in patients with acute pancreatitis. Abbreviations: MBP, mean blood pressure; GCS, Glasgow Coma Scale; CCI, Charlson_comorbidity_index.

Figure 3

ROC curves for the nomogram and other scoring systems. (a) Training set; (b) validation set. Abbreviations: BISAP, blood urea nitrogen, impaired mental status, systemic inflammatory response syndrome, age and pleural effusion; SOFA, Sequential Organ Failure Assessment; SIRS, systemic inflammatory response syndrome.

Figure 4

Calibration curves for the nomogram. (a) Training set; (b) validation set.

Figure 5

Decision curve analysis for the nomogram and other scoring systems. (a) Training set; (b) validation set. Abbreviations: BISAP, blood urea nitrogen, impaired mental status, systemic inflammatory response syndrome, age and pleural effusion; SOFA, Sequential Organ Failure Assessment; SIRS, systemic inflammatory response syndrome.