Introduction: Acute necrotizing pancreatitis (ANP) can result in significant healthcare burden. It is essential to accurately identify patients with a high likelihood of mortality promptly to determine the need for aggressive measures. The present study aimed to develop a new scoring system based on data from the United States population.
Methods: We retrospectively analyzed 22,980 patients diagnosed with acute necrotizing pancreatitis (ANP) using the National Inpatient Sample (NIS) in the validation cohort. The mortality in acute necrotizing pancreatitis at baseline (MANP)-B scoring system was derived using multivariable cox regression analysis and validated using receiver operating characteristic curves in a validation cohort.
Results: Six variables were selected for incorporation into the MANP-B score, including age ≥ 60 years (aHR 2.8 [95% CI 2.03-3.8, P < 0 .001), Peripheral vascular disease (aHR 1.79 [95% CI 1.1-2.8, P < 0 .001), Chronic kidney disease or ESRD (aHR 1.54 [95% CI 1.09-2.2, P < 0 .001), Chronic liver disease (aHR 1.60 [95% CI 1.17-2.17, P < 0 .001), Disorders of coagulation (aHR 1.97 [95% CI 1.34-3.24, P < 0 .001) and fluid or electrolyte imbalance (aHR 2.1 [95% CI 1.34-3.24, P < 0 .001). Each variable was allotted one point except age and fluid/electrolyte imbalance which were allotted two points due to higher hazard ratios. The new scoring system yields a total maximum score of 8 points. Based on the calculated highest sensitivity and specificity values from the receiver operating characteristic (ROC)curves, the determined cut-off values for predicting ANP inpatient mortality at 30-day periods was 4 points using Liu index (Sensitivity 70.14%, Specificity 75.82%) and 3 points for mortality at 7-day periods was 4 points using Liu index (Sensitivity 69.70%, Specificity 78.60%). The area under the curve (AUC) using the ROC curve of derivation cohort was 0.7965 (95% CI 0.74766 - 0.84526, p < 0.01) for 7-day periods. The AUC of the validation cohort 0.8005 (95% CI 0.74612 - 0.85479, p < 0.01) for 7-day periods. The area under the curve (AUC) using the ROC curve of derivation cohort was 0.7905 (95% CI 0.7905 - 0.81896, p < 0.01) for 30-day periods. The AUC of the validation cohort 0.8190 (95% CI 0.78883 - 0.84910, p < 0.01) for 30-day periods.
Discussion: This system can be used as an objective method for predicting seven and 30 day all cause mortality for ANP hospitalizations on admission.
