A prediction model for acute respiratory distress syndrome among patients with severe acute pancreatitis: a retrospective analysis

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a severe complication among patients with severe acute pancreatitis (SAP), which may be associated with increased mortality in hospitalized patients. Thus, an effective model to predict ARDS in patients with SAP is urgently required.

Methods: We retrospectively analyzed the data from the patients with SAP who recruited in Xiangya Hospital between April 2017 and May 2021. Patients meeting the Berlin definition of ARDS were categorized into the ARDS group. Logistic regression models and a nomogram were utilized in the study. Descriptive statistics, logistic regression models, and a nomogram were used in the current study.

Results: Comorbidity of ARDS occurred in 109 (46.58%) of 234 patients with SAP. The SAP patients with ARDS group had a higher 60-day mortality rate, an increased demand for invasive mechanical ventilation, and a longer intensive care unit (ICU) stay than those without ARDS (p < .001 for all). Partial pressure of oxygen (PaO2): fraction of inspired oxygen (FiO2) < 200, platelets <125 × 109/L, lactate dehydrogenase >250 U/L, creatinine >111 mg/dL, and procalcitonin >0.5 ng/mL were independent risk variables for development of ARDS in SAP patients. The area under the curve for the model was 0.814, and the model fit was acceptable [p = .355 (Hosmer-Lemeshow)]. Incorporating these 5 factors, a nomogram was established with sufficient discriminatory power (C-index 0.814). Calibration curve indicated the proper discrimination and good calibration in the predicting nomogram model.

Conclusion: The prediction nomogram for ARDS in patients with SAP can be applied using clinical common variables after the diagnosis of SAP. Future studies would be warranted to verify the potential clinical benefits of this model.

Keywords: ARDS; SAP; acute respiratory distress syndrome; severe acute pancreatitis.

Figure 1.

Flow diagram of the study population.

Figure 2.

Kaplan–Meier curves of mortality for SAP patients with or without ARDS. Patients discharged home considered alive at 60 days. A log-rank test was used to evaluate differences between groups. ARDS, acute respiratory distress syndrome; SAP, severe acute pancreatitis.

Figure 3.

The ROC curves in prediction of ARDS in patients with SAP. (a) ROC curves of present prediction model. (b) ROC curves of SIRS, BISAP, MMF, SOFA, and nomogram. ARDS, acute respiratory distress syndrome; BISAP, bedside index of severity in acute pancreatitis; FiO₂, fraction of inspired oxygen; MMF, modified Marshall scoring system; PaO₂, partial pressure of oxygen; SAP, severe acute pancreatitis; SIRS, systemic inflammatory response syndrome score; SOFA, Sequential Organ Failure Assessment score.

Figure 4.

(a) Developed ARDS prediction nomogram in patients with SAP. (b) Calibration curves of the ARDS nomogram prediction in the SAP trial. ARDS, acute respiratory distress syndrome; FiO₂, fraction of inspired oxygen; PaO₂, partial pressure of oxygen; SAP, severe acute pancreatitis.