Development and Validation of a Novel Prognostic Score Based on Thrombotic and Inflammatory Biomarkers for Predicting 28-Day Adverse Outcomes in Patients with Acute Pancreatitis

Abstract

Background

Acute pancreatitis (AP) is a multifactorial disease that is associated with substantial morbidity and mortality. Thrombosis and inflammation are involved in the development and progression of AP.

Aim

To develop and validate a novel and simple scoring system for predicting 28-day adverse outcomes in AP patients based on a thrombotic and an inflammatory biomarker.

Methods

A single-center, retrospective cohort study was used to establish the new scoring system (thrombo-inflammatory prognostic score; TIPS), and another study was used to verify it. The study end points were 28-day mortality, requirement for mechanical ventilation (MV), persistent organ failure (POF), and admission to the intensive care unit (AICU). Receiver operating characteristic (ROC) curves was drawn to validate the predictive value of the TIPS. The performance of the TIPS was compared with that of conventional predictive scoring systems. Logistic regression models were used to investigate the relationship between the TIPS and the different end points.

Results

Among 440 patients with AP in the derivation group, 27 patients died within the 28-day follow-up period. Prothrombin time (PT) and interleukin-6 (IL-6) were used to calculate the TIPS. The TIPS (AUC=0.843) showed a performance comparable to that of the more established APACHE II (AUC=0.841), SOFA (AUC=0.797), BISAP (AUC=0.762), and Balthazar CT (AUC=0.655) in predicting 28-day mortality in AP. The 28-day mortality and the incidence of MV, POF, and AICU were significantly higher among patients with a higher TIPS (P<0.001). The results of logistic regression analyses indicated that the TIPS was independently associated with the risks of 28-day mortality, AICU, MV and POF.

Conclusion

The TIPS can enable prediction of 28-day adverse clinical outcomes with AP patients in the ED.

Keywords:

• acute pancreatitis
• prognosis
• clinical outcomes
• thrombosis
• inflammation

Acknowledgment

We would like to thank all the volunteers who took part in this study and all the participants for their contribution to data collection and analysis.

Disclosure

The authors have no potential conflicts of interest to disclose.

Additional information

Funding

This work was supported by Key R&D Project of Sichuan Provincial Department of Science and Technology (2021YFS0023). Technology Innovation Project of Key R & D Support Plans of Chengdu Science and Technology Municipality (2020-YF05-00074-SN). Project of the Beijing Medical and Health Foundation (YWJKJJHKYJJ-B184096-Q26).