Introduction

Predicting severity of acute pancreatitis enables optimization of care, reducing morbidity and length of stay. Modified adult scoring systems have not been able to adequately predict severity in children.

Methods

This was a retrospective study of children presenting with a first episode of acute pancreatitis from 2002 to 2020 in a single tertiary paediatric surgical centre. Serum markers including CRP at 48 h of admission were analysed. Promising biomarkers underwent ROC (Receiver Operating Curve) analysis, and these were compared to the modified Glasgow Pancreas Score. An AUC (Area Under Curve) > 0.90 was taken as an excellent predictor of severity.

Results

Data of 59 children were analysed, median age 13 years. 22 patients (37%) had a severe episode. ROC analysis demonstrated CRP as the best predictor of severity giving an AUC of 0.92. Optimum cut off value for CRP was 107.5 mg/L (p < 0.0001) producing sensitivity of 91%, specificity of 84%. This was superior to the modified Glasgow Pancreas score, which produced a sensitivity of 36% and specificity of 100%.

Conclusion

We have shown that a CRP value of > 108 mg/L within 48 h of admission can be used to predict severity of acute pancreatitis in children with greater accuracy than current scoring systems.

Type of study

Diagnostic test.

Level of evidence

Level I.

中文翻译：

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C反应蛋白准确预测儿童急性胰腺炎的严重程度

介绍

预测急性胰腺炎的严重程度可以优化护理，减少发病率和住院时间。修改后的成人评分系统无法充分预测儿童的严重程度。

方法

这是一项回顾性研究，研究对象为 2002 年至 2020 年在一家三级儿科外科中心首次出现急性胰腺炎的儿童。分析了入院 48 小时时的血清标志物，包括 CRP。有希望的生物标志物进行了 ROC（接受者操作曲线）分析，并将这些与修改后的 Glasgow Pancreas 评分进行了比较。AUC（曲线下面积）> 0.90 被视为严重程度的极好预测指标。

结果

分析了 59 名儿童的数据，中位年龄为 13 岁。22 名患者 (37%) 有严重的发作。ROC 分析表明 CRP 是严重程度的最佳预测指标，AUC 为 0.92。CRP 的最佳截止值为 107.5 mg/L ( p  < 0.0001)，灵敏度为 91%，特异性为 84%。这优于改良的 Glasgow Pancreas 评分，后者产生 36% 的敏感性和 100% 的特异性。

结论

我们已经表明，入院 48 小时内 CRP 值 > 108 mg/L 可用于预测儿童急性胰腺炎的严重程度，比目前的评分系统更准确。

研究类型

诊断测试。

证据级别

一级。