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Predicting Persistent Acute Respiratory Failure in Acute Pancreatitis: The Accuracy of Two Lung Injury Indices

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Abstract

Background/Aims

Early and accurate identification of patients with acute pancreatitis (AP) at high risk of persistent acute respiratory failure (PARF) is crucial. We sought to determine the accuracy of simplified Lung Injury Prediction Score (sLIPS) and simplified Early Acute Lung Injury (sEALI) for predicting PARF in ward AP patients.

Methods

Consecutive AP patients in a training cohort from West China Hospital of Sichuan University (n = 912) and a validation cohort from The First Affiliated Hospital of Nanchang University (n = 1033) were analyzed. PARF was defined as oxygen in arterial blood/fraction of inspired oxygen < 300 mmHg that lasts for > 48 h. The sLIPS was composed by shock (predisposing condition), alcohol abuse, obesity, high respiratory rate, low oxygen saturation, high oxygen requirement, hypoalbuminemia, and acidosis (risk modifiers). The sEALI was calculated from oxygen 2 to 6 L/min, oxygen > 6 L/min, and high respiratory rate. Both indices were calculated on admission.

Results

PARF developed in 16% (145/912) and 22% (228/1033) (22%) of the training and validation cohorts, respectively. In these patients, sLIPS and sEALI were significantly increased. sLIPS ≥ 2 predicted PARF in the training (AUROC 0.87, 95% CI 0.84–0.89) and validation (AUROC 0.81, 95% CI 0.78–0.83) cohorts. sLIPS was significantly more accurate than sEALI and current clinical scoring systems in both cohorts (all P < 0.05).

Conclusions

Using routinely available clinical data, the sLIPS can accurately predict PARF in ward AP patients and outperforms the sEALI and current existing clinical scoring systems.

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Acknowledgments

TJ and LD are correspondence authors with equal contributions. These authors thank all the staff from pancreas multidisciplinary team at West China Hospital and First Affiliated Hospital of Nanchang University for their continuous support. This study was supported by Key Research and Development Project of Science and Technology Department of Sichuan Province (No. 2021YFS0250); NZ-China Strategic Research Alliance 2016 Award (Ministry of Science and Technology, China [Grant No. 2016YFE0101800], QX, TJ, WH, and LD; Health Research Council, New Zealand, ARP and JAW), and National Institute for Health Research Senior Investigator Award (RS).

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Authors and Affiliations

  1. West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China

    Lan Li, Shiyu Liu, Xiaoying Zhang, Ping Zhu, Jiahua Shi, Na Shi, Wei Huang, Lihui Deng, Tao Jin & Qing Xia

  2. Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China

    Wenhua He, Liang Xia, Nonghua Lu & Yin Zhu

  3. Chinese Evidence-Based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, China

    Wen Wang & Xing Sun

  4. Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand

    Anthony R. Philips

  5. Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    Anthony R. Philips & John A. Windsor

  6. Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, USA

    Vikesh K. Singh

  7. Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Translational Medicine, University of Liverpool, Liverpool, UK

    Robert Sutton

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  1. Lan Li
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  2. Shiyu Liu
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  3. Xiaoying Zhang
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  4. Wenhua He
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  8. Xing Sun
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  9. Na Shi
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  11. Nonghua Lu
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  12. Anthony R. Philips
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  19. Tao Jin
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  20. Qing Xia
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Contributions

Study concept, design, and obtaining funding: TJ, LD, QX, and WH. Data acquisition: LL, LD, SL, XZ, WH, PZ, WW, XS, NS, LX, and NL, and YZ. Statistical analysis and interpretation of data: LL and PZ. Drafting of Manuscript: LL and WH. Important intellectual input: ARP, VKS, and RS. Critical revision of the manuscript: JAW. All authors have approved the final version of manuscript submitted.

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Correspondence to Tao Jin.

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Li, L., Liu, S., Zhang, X. et al. Predicting Persistent Acute Respiratory Failure in Acute Pancreatitis: The Accuracy of Two Lung Injury Indices. Dig Dis Sci 68, 2878–2889 (2023). https://doi.org/10.1007/s10620-023-07855-y

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