Accurate prediction of acute pancreatitis severity with integrative blood molecular measurements

Abstract

Background: Early diagnosis of severe acute pancreatitis (SAP) is essential to minimize its mortality and improve prognosis. We aimed to develop an accurate and applicable machine learning predictive model based on routine clinical testing results for stratifying acute pancreatitis (AP) severity. Results: We identified 11 markers predictive of AP severity and trained an AP stratification model called APSAVE, which classified AP cases within 24 hours at an average area under the curve (AUC) of 0.74 +/- 0.04. It was further validated in 568 validation cases, achieving an AUC of 0.73, which is similar to that of Ranson’s criteria (AUC = 0.74) and higher than APACHE II and BISAP (AUC = 0.69 and 0.66, respectively). Conclusions: We developed and validated a venous blood marker-based AP severity stratification model with higher accuracy and broader applicability, which holds promises for reducing SAP mortality and improving its clinical outcomes. Materials and Methods: Nine hundred and forty-five AP patients were enrolled into this study. Clinical venous blood tests covering 65 biomarkers were performed on AP patients within 24 hours of admission. An SAP prediction model was built with statistical learning to select biomarkers that are most predictive for AP severity.

Clinical usefulness of scoring systems to predict severe acute pancreatitis: A systematic review and meta‐analysis with pre and post‐test probability assessment

“…Table 1 presents a summary of relevant studies. The 43 studies 24–65 included 14,116 AP patients, with mean/median age ranging widely (35–72 years) as the rate of male patients (34%–86%).…”

“…Thirty‐four studies (79%) took place in Institutions in Asia, 24–28,30–35,37,39,41–52,54–56,58–62,65 7 in Europe, 36,38,40,53,57,63,64 2 in the USA 9,29 . Twenty‐one studies were prospective, 9,25,29,32–36,38,41,44,45,47,51–54,57,59,61,65 21 retrospective 24,26–28,30,31,37,39,40,42,46,48–50,55,56,58,60,62–64 and 1 cross‐sectional 43 . Three of the studies included both training and validation sets, 9,37,39 and one two cohorts of different age groups 50 .…”

“…There were 42 studies investigating BISAP 9,24–41,43–65 in a total of 13,944 patients. In these studies, the pooled prevalence of severity (pre‐test probability) was 17.8% (14.3%–22.2%) with considerable heterogeneity ( I 2 = 96.9%) (Supplementary Figure ).…”

“…Thirty-four studies (79%) took place in Institutions in Asia, [24][25][26][27][28][30][31][32][33][34][35]37,39,[41][42][43][44][45][46][47][48][49][50][51][52][54][55][56][58][59][60][61][62]65 7 in Europe, 36,38,40,53,57,63,64 2 in the USA. 9,29 Twenty-one studies were prospective, 9,25,29,[32][33][34][35][36]38,…”

Identification of novel immune-related targets mediating disease progression in acute pancreatitis

“…AP is a complex inflammatory disease with diverse characteristics in terms of severity and course. While the therapeutic strategy and stratification systems currently used for AP are generally useful, the effectiveness and accuracy of these methods still need to be improved to reduce the mortality rate and improve early diagnosis of AP ( Gukovskaya et al., 2017 ; Lee and Papachristou, 2019 ; Leppaniemi et al., 2019 ; Sun et al., 2021 ).…”