Figure - available from: PLOS One
This content is subject to copyright.
SROC curve of the (a) Ranson and (b) BISAP for predicting pancreatic necrosis in AP SROC, Summary receiver operating characteristic; BISAP, Bedside Index of Severity in Acute Pancreatitis; AP, acute pancreatitis.
Source publication
Background
To systematically assess and compare the predictive value of the Ranson and Bedside Index of Severity in Acute Pancreatitis (BISAP) scoring systems for the severity and prognosis of acute pancreatitis (AP).
Methods
PubMed, Embase, Cochrane Library, and Web of Science were systematically searched until February 15, 2023. Outcomes in this...
Citations
... There are some studies that encounter better specificity and sensitivity for the severity of disease of the Ranson score and BISAP score. A study published in 2024 by Jianpeng Zu et al. presents, following a meta-analysis, a pooled sensitivity for severity for the Ranson score and BISAP score of 95% and 67%, a pooled specificity for both scores of 74% and 95%, and a pooled accuracy of Ranson score and BISAP score of 95% and 94% [43]. ...
Background: The optimal management of patients with acute pancreatitis is directly related to the early detection of the mild, moderate, or severe forms of the disease, which remains a continuous challenge despite the availability of various severity scores. The aim of this study was to identify prognostic factors with the highest predictive value specific to the local patients and elaborate the score to identify the severe cases. Materials and Methods: A retrospective observational cohort study included 172 patients diagnosed with acute pancreatitis. Personal, clinical, laboratory, and imaging factors and their influence on the severity of acute pancreatitis were evaluated. Results: Etiology nonA-nonB (any etiology except unique alcoholic or biliary etiology), presence of diabetes mellitus, the pain Visual Analogue Scale (VAS), White Blood Cells (WBCs), and CRP (C-reactive protein) levels were found to be directly associated with the severity of acute pancreatitis (AP). Prediction scores were calculated to estimate disease severity using the following regression equations: Prediction Acute Pancreatitis Severity (PAPS) score I = 1.237 + 0.144 × nonA-nonB (0 = no, 1 = yes) + 0.001 × WBC1 + 0.027 × VAS0 and PAPS score II = 1.189 + 0.001 × CRP (mg/L) + 0.135 × nonA-nonB etiology (0 = no, 1 = yes) + 0.025 × VAS0 − 0.047 × CA1. The PAPS Score II demonstrated the best performance. At a cut-off value of 1.248, the score had 80% sensitivity, 80.9% specificity, a positive predictive value (PPV) of 28.6%, a negative predictive value (NPV) of 97.7%, and an accuracy of 80.8%. For a cut-off value of 221.5 mg/L, the accuracy of CRP was 81.4% for predicting severe AP. Conclusions: The PAPS score II is an easy-to-use, fast, and affordable score for determining cases of severe disease for patients diagnosed with AP.
... This suggests that RAR may be a more effective predictive marker for identifying individuals with acute pancreatitis who are at a higher risk of early mortality. Although the RAR has a relatively lower AUC compared to traditional scoring systems such as RANSON and Bedside Index of Severity in Acute Pancreatitis (BISAP) scoring systems [19], it demonstrates distinct advantages in terms of timeliness and cost-effectiveness. ...
Objective
The association between red blood cell distribution width-to-albumin (RDW/ALB) ratio (RAR) and all-cause mortality in patients with acute pancreatitis has not been fully delineated. The purpose of this study was to investigate the impact of RAR at admission on 28-day all-cause mortality in patients with acute pancreatitis.
Design
This investigation was conducted as a retrospective analysis utilizing data from the Medical Information Mart for Intensive Care (MIMIC)-III database.
Participants
Patients with acute pancreatitis were selected from the MIMIC-III database according to predefined eligibility criteria.
Outcome
The outcome was the all-cause mortality rates within 28 days.
Results
Upon screening and excluding ineligible participants, a total of 931 patients with acute pancreatitis who met the inclusion criteria were analyzed. The overall mortality at 28 days was 11.71%. The receiver operating characteristic (ROC) analysis indicated that RAR had a moderate predictive value for all-cause mortality at 28 days, with an area under the curve (AUC) of 0.669 (95%CI, 0.617–0.720; p<0.05), and the cutoff value was 4.39. Divide the patients into a high RAR group and a low RAR group based on the cutoff value. Kaplan-Meier survival analysis demonstrated a statistically significant increase in 28-day mortality among patients in the high RAR group compared to those in the low RAR group. Multivariate analysis indicated that potassium levels, total bilirubin, blood urea nitrogen, lactate, partial thromboplastin time, neutrophil and RAR were independently associated with the 28-day mortality. Multivariate Cox regression analysis confirmed that an elevated RAR was independently associated with increased mortality at 28 day (HR, 2.72; 95% CI, 1.64–4.52; p < 0.001).
Conclusions
This study demonstrated that RAR at admission functioned as a significant prognostic indicator for mortality in patients with acute pancreatitis.
... [14] Примітно, що традиційні прогностичні шкали (BISAP, SIRS, mCTSI) не показали достатньої прогностичної цінності на ранніх стадіях захворювання. [15] Це підтверджує обмеження існуючих систем оцінки, які не враховують гетерогенність варіантів перебігу ОН при ГП. Особливо важливим є те, що ці шкали не дозволяють диференціювати пацієнтів за ризиком розвитку різних варіантів ОН на ранніх етапах захворювання, що критично важливо для визначення оптимальної лікувальної тактики. ...
Intoroduction. Acute pancreatitis remains one of the most challenging diseases in abdominal surgery, particularly due to the high incidence of organ failure, occurring in 15-20% of patients and associated with mortality rates up to 42% during the first week of hospitalization. Early identification of patients at high risk for organ failure development is of particular importance. It, in turn, is a key factor determining the severity of the course and prognosis of the disease, developing in 15-20% of patients with acute pancreatitis. At the same time, persistent organ failure is associated with mortality of up to 42% during the first week of hospitalization. There are several scales for assessing the severity of acute pancreatitis, including: Acute Physiologic Assessment and Chronic Health Evaluation II, Bedside Index of Severity in Acute Pancreatitis and the modified Marshall scale, but none of them demonstrates accuracy in predicting the development of organ failure, and the maximum sensitivity reaches only 75%. The objective of this study was to identify and characterize the main patterns of organ failure in acute pancreatitis based on comprehensive analysis of clinical indicators, laboratory parameters, and temporal disease characteristics. Subjects and methods. This retrospective study included 82 patients (2014-2019), stratified into groups with organ failure (n=41) and without it (n=41). The assessment protocol included clinical parameters, laboratory findings, and disease progression dynamics. Cluster analysis was used to determine organ failure patterns. Results. Three main patterns were identified: “early respiratory” (37.5% of cases), “late progressive” (57.5%), and “multisystem” (5.0%), each differing in onset timing, organ system involvement, and clinical outcomes. The "multisystem" pattern exhibited the most unfavorable profile, with the longest hospitalization duration (median 68.0 days) and highest mortality. The study identified key prognostic markers and developed a risk stratification system, enabling optimized monitoring and treatment strategies based on the organ failure pattern.
Background: Severe acute pancreatitis (SAP) patients in intensive care units (ICU) frequently experience multidimensional discomfort, yet validated tools like the Chinese version of the Inconforts des Patients de REAnimation (IPREA-China) remain underutilized in this population. Guided by Kolcaba’s comfort theory, this study aimed to fill the gap in understanding and managing discomfort in SAP patients. Objective: To assess discomfort levels using the IPREA-China, identify predictors of severity, and propose effective intervention strategies. Design: A single-center, cross-sectional study adhering to STROBE guidelines. Setting(s): Conducted at the Pancreatitis Diagnostic and Treatment Center in Guizhou Province, China, equipped with 70 ICU beds and specialized multidisciplinary care. Participants: Within 24 hours of transfer from the ICU, 245 conscious SAP patients completed the IPREA-China questionnaire between January 2021 and October 2023. Methods: Data were collected via convenience sampling, encompassing demographic information, disease-related data (APACHE-II, BISAP, Barthel Index), and IPREA-China scores. The IPREA-China scale assessed 17 discomfort items across three dimensions: psychological/physical, environmental, and physiological needs. Ordered logistic regression analysis was used to identify predictors of discomfort severity among demographic and clinical disease characteristics. Results: All 245 patients reported discomfort during ICU stays, with a median total score of 59 (IQR: 53–72). Discomfort severity was categorized as mild (15.1%), moderate (73.1%), or severe (11.8%), with moderate discomfort being predominant. Key findings include: Mental and Physical Discomforts: Moderate discomfort was predominant, driven by pain (59.2%), anxiety (51.4%), and restricted mobility (49.4%). Environment-related Discomforts: Mild discomfort prevailed, with noise (53.9%), sleep disturbances (55.5%), and bed-related discomfort (59.6%) as major contributors. Physiological Need-related Discomforts: Notably, thirst had the highest total score, with thirst emerging as the most severe symptom (57.6% mild, 17.1% severe), followed by hunger (14.7%). Multivariate analysis identified the following independent predictors of a higher degree of discomfort: male gender (β=3.983), recurrence (β=1.619), mechanical ventilation (β=6.980), diarrhea (β=3.213), low Barthel Index (β=-0.185), and high BISAP scores (β=2.286). Lack of appetite (β=-3.763) was associated with a lower degree of discomfort. Conclusions: The IPREA-China effectively identifies the core discomfort sources in SAP patients. For high-risk groups, such as males, those with recurrence, mechanical ventilation, diarrhea, and high BISAP scores, an integrated 4D intervention strategy that encompasses physical, psychological, social, and environmental measures, along with STEP-CARE framework prioritizing sleep, thirst, environment, and pain management, should be adopted to alleviate discomfort and enhance the ICU treatment experience for SAP patients.
Objectives
Globally, endometrial cancer (EC) is currently one of the most common gynecologic malignancies among females. Preoperative infiltration depth analysis is important for disease progression and prognostic impact. This study aimed to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in the infiltration depth analysis of EC.
Method
Electronic databases PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP were searched for more extensive literature on CEUS in the diagnosis of myometrial infiltration in EC patients up to March 29, 2024. Cochran Q and I² were used to assess the heterogeneity of eligible studies. Sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were analyzed for each clinical outcome using a bivariate random effects model. Summary receiver operating characteristic (SROC) curves were also generated.
Results
In total, 23 papers with 1247 EC patients were included in the meta-analysis. The SEN, SPE, PLR, NLR, and DOR for the diagnosis of deep myometrial infiltration (DMI) of EC using CEUS were 0.84 [95% confidence interval (CI): 0.79, 0.89], 0.92 (95%CI: 0.90, 0.94), 11.05 (95%CI: 8.00, 15.25), 0.17 (95%CI: 0.12, 0.23), and 64.91 (95%CI: 37.11, 113.52), respectively. The area under the curve (AUC) was 0.95 (95%CI: 0.93, 0.97). For the diagnosis of superficial myometrial invasion (SMI) of EC by CEUS, the SEN, SPEN, PLR, NLR, DOR and AUC were 0.91 (95%CI: 0.85, 0.95), 0.80 (95%CI: 0.64, 0.90), 4.55 (95%CI: 2.34, 8.85), 0.11 (95%CI: 0.06, 0.21), 41.40 (95%CI: 12.14, 141.13), and 0.94 (95%CI: 0.91, 0.95), respectively.
Conclusion
CEUS might be a reliable and practical technique for EC myometrial infiltration diagnosis. More clinical data and studies are still needed to confirm these results in the future.
