Multivariate Model for the Prediction of Severity of Acute Pancreatitis in Children

Abstract

This study aimed to develop a severity prediction system for pediatric patients with acute pancreatitis (AP) based on clinical and laboratory parameters recorded at disease onset. A retrospective cohort study including 130 patients with AP, aged 0 to 18 years, was conducted. Correlations between severe AP (SAP) and clinical and laboratory data were established. Parameters with a significant statistical correlation (P ≤ 0.05) were incorporated in logistic regression models, and receiver operating characteristic curves were generated. The best-performance cutoff points were calculated to propose a severity prediction score, for which sensitivity and specificity were determined. Thirty-eight cases (29.2%) were consistent with SAP. A value of ≥1 point yielded a sensitivity of 81.5% and specificity of 64.1% for SAP prediction, when using a score including blood urea nitrogen ≥12.5 mg/dL (1 point) or hemoglobin <13 mg/dL (1 point) as variables. The proposed severity score showed good performance in predicting SAP.

The course of acute pancreatitis in children and potential simple laboratory markers of severity – A single Centre retrospective study

“…16 The association between the severity of AP and pancreatic enzymes levels has been assessed in previous research. 7,10,16,19,27,28 In the present study, there were no statistically significant differences between the severity of the disease and amylase and lipase activities on admission and after 48 h. Adult studies failed to show that pancreatic enzymes levels are associated with the development of severe AP. 16,27 the serum lipase ≥7 the upper limit of the normal reference range within 24 h of presentation as a simple single marker of the severity of AP in children.…”

“…Additionally, in the Izquierdo et al study no statistical association was found between SAP and serum lipase level. The authors proposed the severity score including blood urea nitrogen and haemoglobin for SAP prediction 19 …”

“…14,[16][17][18] Various laboratory parameters have been evaluated as potential markers of AP severity in adults and children. The results of the research have been equivocal 7,8,10,16,[19][20][21][22][23][24][25][26][27][28] . The present study revealed that paediatric patients with severe AP had higher WBC and PLT counts on admission as well as a CRP concentration after 48 h. These parameters are known, but not specific, inflammation biomarkers.…”

“…The authors proposed the severity score including blood urea nitrogen and haemoglobin for SAP prediction. 19 The strength of this study is the use of the classification of AP according to the NASPGHAN recommendations. 4 Many previous studies report various, wide-ranging definitions of SAP.…”

“…Exclusively certain laboratory parameters that were fully available in the medical records were analysed. Other previously reported tests which could be predictors for severe AP in children like lactate dehydrogenase, calcium, albumin, blood urea nitrogen and interleukin-6 15,16,19,21,[24][25][26]28 were infrequently taken. Moreover, the study population was small, especially in the severe group due to the relative rarity of organ failure and pancreatic complications in children.…”