急性胰腺炎的預(yù)后-POP評(píng)分課件

ThePancreatitisOutcomePrediction(POP)Score:Anewprognosticindexforpatientswithsevereacutepancreatitis急性胰腺炎的預(yù)后-POP評(píng)分急性胰腺炎的預(yù)后-POP評(píng)分CausesofacutepancreatitisWell-establishedcausesGallstones40%Alcoholism35%HypertriglyceridemiaPost–endoscopicretrogradecholangiopancreatographyDruginducedAutoimmuneGeneticAbdominaltraumaPostoperativeIschemiaInfectionsHypercalcemiaandhyperparathyroidismScorpionvenomPancreasdivisumwithductularnarrowingonpancreatogramIdiopathicControversialcausesSphincterofOddidysfunctionPancreasdivisumwithoutductalnarrowingonpancreatogramMicrolithiasis/sludge急性胰腺炎的預(yù)后-POP評(píng)分EpidemiologyIncidence:variesfrom4.8to24.2per100,000inEngland,Denmark,andtheUnitedStatesUpto20%ofpatientswithacutepancreatitiswilldevelopseverepancreatitisOverallmortalityisreportedas10%to15%mildacutepancreatitis:<5%severeacutepancreatitis:20%to25%急性胰腺炎的預(yù)后-POP評(píng)分Causeofdeathfirsttwoweeks:duetosystemicinflammatoryresponsesyndromeandorgenfailureaftertwoweeks:duetosepsisanditscomplicationsAccuratepredictorsoftheseverityofacutepancreatitisareimportantbecausetheyinfluenceclinicaldecisionmakingregardingtherapeuticinterventions急性胰腺炎的預(yù)后-POP評(píng)分PrognosticscoringsystemsVariousprognosticscoringsystemshavebeendevelopedyetsuchasAtlantaclassificationtheRanson,andGlasgowcriteria急性胰腺炎的預(yù)后-POP評(píng)分ProblemCollectedseveraldecadesagoContainingasmallproportionofpatientswithsevereacutepancreatitisTake48htocompleteDonothaveahighdegreeofsensitivityandspecificity急性胰腺炎的預(yù)后-POP評(píng)分AnewprognosticindexforpatientswithsevereacutepancreatitisThePancreatitisOutcomePrediction(POP)ScoreArterialpHAgeSerumureaMeanarterialpressurePaO2/FiO2ratioTotalserumcalcium急性胰腺炎的預(yù)后-POP評(píng)分POPScoreretrospectivecohortstudyfrom1995to20032,462patientswithsevereacutepancreatitisadmittedto159U.K.intensivecareunits急性胰腺炎的預(yù)后-POP評(píng)分POPScoreVariablesforthemodelwereselectedbasedonananticipatedrelationshipwithmortalityfromexistingmodelsforpancreatitisandexpertclinicalopinionmeasurementswereassessedoverthefirst24hrsfollowingadmissiontoICU急性胰腺炎的預(yù)后-POP評(píng)分POPScoreThevariablesincludedintheinitialfullmodelwere:age,genderoperativestatus,meanarterialpressurePaO2/FiO2ratio,arterialpHserumurea,serumcreatinineserumglucose,totalserumcalciumtotalserumbilirubin,serumalbuminwhitebloodcellcount,plateletcount急性胰腺炎的預(yù)后-POP評(píng)分POPScoreAllvariableswereenteredintoamultiplelogisticregressionmodelStepwisemodelselectionSixvariableswiththestrongestrelationshiptooutcomewereusedtodevelopthePOPscore,rangingfrom0to40points急性胰腺炎的預(yù)后-POP評(píng)分PancreatitisOutcomePredictionScore急性胰腺炎的預(yù)后-POP評(píng)分PredictedprobabilityofultimatehospitalmortalityfromthePancreatitisOutcomePredictionScore急性胰腺炎的預(yù)后-POP評(píng)分急性胰腺炎的預(yù)后-POP評(píng)分thedatasetwasnotcollectedforthepurposeofidentifyingpatientswithpancreatitis.Itwasthereforenotpossibletovalidatethediagnosisofpancreatitis(e.g.,basedonamylaselevelsorcomputedtomographyscans)ortoevaluateallpotentialprognosticvariables(e.g.,serumlactatedehydrogenaseaswasincludedinthemodifiedGlasgowcriteria).Otherpertinentdetails,suchastheetiologyofthepancreatitisandcomorbiditiessuchasdiabetesandnonsevereheartfailure,arealsomissing.WealsolackdatacollectedatICUadmissionforthesepatientstotestthevalidityofthePOPScoreatthisearliertimepoint.急性胰腺炎的預(yù)后-POP評(píng)分CaseBed5XXXAPACHEII:33Predictedmortality:77.8%急性胰腺炎的預(yù)后-POP評(píng)分UponarrivalAge≥55√WBC>16,000√BG>200mg/dL√LDH>2*Normal√ALT>6*NormalAt48hafteradmissionHct<30%orfall>10%√Calcium<8mg/dL√BUNincrease>5mg/dL√PaO2<60mmHgB