Risk factors and prediction model construction for acute biliary pancreatitis complicated with common bile duct stones

doi:10.11958/20251377

Abstract

Abstract:

Objective To analyze the risk factors and construct prediction model for acute biliary pancreatitis (ABP) complicated by common bile duct stones (CBDS). Methods A total of 105 patients with CBDS complicated by ABP were included as the ABP group, and another 105 CBDS patients without ABP were included as the non-ABP group. Clinical data of all patients were collected. Multivariate unconditional Logistic regression was used to identify the risk factors for CBDS complicated by ABP, and a nomogram predictive model was developed accordingly. The H-L test was used to evaluate the fit degree of the model. The predictive value was assessed by the receiver operating characteristic (ROC) curve. C-index analysis was used to predict the discriminatory ability of the model. Calibration curve was used to analyze and predict the accuracy of the model. The decision curve was used to analyze clinical benefits of the model. Results Logistic regression analysis showed that older age, diabetes, larger stone diameter, larger common bile duct diameter, higher neutrophil-to-lymphocyte ratio (NLR), elevated serum amylase (AMS) and higher C-reactive protein (CRP) levels were independent risk factors for CBDS complicated by ABP (P<0.05). A nomogram predictive model was constructed based on these factors, and the H-L test showed good model fit (P > 0.05). The ROC curve indicated an area under the curve (AUC) of 0.884, and the C-index was 0.884. The calibration curve demonstrated that the predicted probabilities were close to the ideal line, and the decision curve showed a wide range of net benefit. Conclusion The nomogram predictive model based on the identified risk factors for CBDS complicated by ABP shows good predictive performance. Keywords: common bile duct stones; pancreatitis; risk factors; nomogram; acute biliary pancreatitis

CLC Number:

R576.1

Figures/Tables 8

References 23

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组别	性别				年龄/岁		体质量指数/（kg/m²）				基础疾病
组别	男		女		年龄/岁		体质量指数/（kg/m²）				高脂血症		糖尿病				高血压
非ABP组	65（61.90）		40（38.10）		54.60±7.00		22.43±1.97				34（32.38）		10（9.52）				40（38.10）
ABP组	60（57.14）		45（42.86）		59.74±5.87		22.81±1.85				38（36.19）		31（29.52）				42（40.00）
χ²或t	0.494				5.769^＊＊		1.421				0.338		13.366^＊＊				0.080
组别	饮酒史		吸烟史		结石数量					结石直径/mm			胆总管直径/mm				WBC/（×10⁹/L）
组别	饮酒史		吸烟史		多发		单发			结石直径/mm			胆总管直径/mm				WBC/（×10⁹/L）
非ABP组	25（23.81）		44（41.90）		41（39.05）		64（60.95）			6.18±2.24			11.26±2.03				8.12±2.79
ABP组	27（25.71）		50（47.62）		56（53.33）		49（46.67）			7.58±2.04			12.15±1.73				8.52±2.44
χ²或t	0.102		0.693		4.311^＊					4.755^＊＊			3.442^＊				1.117
组别	Hb/（g/L）		PLT/（×10⁹/L）			NLR			DBIL/（μmol/L）			IBIL/（μmol/L）			TBIL/（μmol/L）
非ABP组	111.63±16.20		237.83±45.96			2.23±0.88			22.23±6.83			18.11±3.38			29.48±6.72
ABP组	109.43±15.17		228.78±63.96			3.16±0.92			23.40±7.52			18.17±3.88			31.47±8.81
t	1.106		1.178			7.442^＊＊			1.179			0.118			1.838
组别	AST/（U/L）	ALT/（U/L）		AMS/（U/L）				ALB/（g/L）			Scr/（μmol/L）			BUN/（mmol/L）		CRP/（mg/L）
非ABP组	52.01±6.56	55.25±7.28		129.30±22.26				40.46±5.13			73.36±12.06			5.26±1.18		9.74±3.02
ABP组	52.06±8.13	55.66±7.86		149.34±31.66				39.22±5.04			73.56±11.95			5.28±1.29		12.36±3.43
t	0.052	0.396		5.308^＊＊				1.766			0.120			0.112		5.853^＊＊

组别	性别				年龄/岁		体质量指数/（kg/m²）				基础疾病
组别	男		女		年龄/岁		体质量指数/（kg/m²）				高脂血症		糖尿病				高血压
非ABP组	65（61.90）		40（38.10）		54.60±7.00		22.43±1.97				34（32.38）		10（9.52）				40（38.10）
ABP组	60（57.14）		45（42.86）		59.74±5.87		22.81±1.85				38（36.19）		31（29.52）				42（40.00）
χ²或t	0.494				5.769^＊＊		1.421				0.338		13.366^＊＊				0.080
组别	饮酒史		吸烟史		结石数量					结石直径/mm			胆总管直径/mm				WBC/（×10⁹/L）
组别	饮酒史		吸烟史		多发		单发			结石直径/mm			胆总管直径/mm				WBC/（×10⁹/L）
非ABP组	25（23.81）		44（41.90）		41（39.05）		64（60.95）			6.18±2.24			11.26±2.03				8.12±2.79
ABP组	27（25.71）		50（47.62）		56（53.33）		49（46.67）			7.58±2.04			12.15±1.73				8.52±2.44
χ²或t	0.102		0.693		4.311^＊					4.755^＊＊			3.442^＊				1.117
组别	Hb/（g/L）		PLT/（×10⁹/L）			NLR			DBIL/（μmol/L）			IBIL/（μmol/L）			TBIL/（μmol/L）
非ABP组	111.63±16.20		237.83±45.96			2.23±0.88			22.23±6.83			18.11±3.38			29.48±6.72
ABP组	109.43±15.17		228.78±63.96			3.16±0.92			23.40±7.52			18.17±3.88			31.47±8.81
t	1.106		1.178			7.442^＊＊			1.179			0.118			1.838
组别	AST/（U/L）	ALT/（U/L）		AMS/（U/L）				ALB/（g/L）			Scr/（μmol/L）			BUN/（mmol/L）		CRP/（mg/L）
非ABP组	52.01±6.56	55.25±7.28		129.30±22.26				40.46±5.13			73.36±12.06			5.26±1.18		9.74±3.02
ABP组	52.06±8.13	55.66±7.86		149.34±31.66				39.22±5.04			73.56±11.95			5.28±1.29		12.36±3.43
t	0.052	0.396		5.308^＊＊				1.766			0.120			0.112		5.853^＊＊

变量	β	SE	Wald χ²	P	OR	OR 95%CI
年龄	1.054	0.293	12.928	<0.001	2.869	1.615~5.095
糖尿病	1.482	0.290	26.160	<0.001	4.400	2.494~7.763
结石数量	1.291	0.721	3.207	0.073	3.638	0.885~14.950
结石直径	0.550	0.243	5.111	0.024	1.733	1.073~2.793
胆总管直径	0.584	0.253	5.345	0.021	1.794	1.093~2.944
NLR	1.318	0.264	24.990	<0.001	3.738	2.229~6.267
AMS	0.880	0.246	12.798	<0.001	2.412	1.489~3.907
CRP	1.124	0.255	19.503	<0.001	3.077	1.869~5.068
常量	-5.890	0.494	142.449	<0.001	0.000	-

变量	β	SE	Wald χ²	P	OR	OR 95%CI
年龄	1.054	0.293	12.928	<0.001	2.869	1.615~5.095
糖尿病	1.482	0.290	26.160	<0.001	4.400	2.494~7.763
结石数量	1.291	0.721	3.207	0.073	3.638	0.885~14.950
结石直径	0.550	0.243	5.111	0.024	1.733	1.073~2.793
胆总管直径	0.584	0.253	5.345	0.021	1.794	1.093~2.944
NLR	1.318	0.264	24.990	<0.001	3.738	2.229~6.267
AMS	0.880	0.246	12.798	<0.001	2.412	1.489~3.907
CRP	1.124	0.255	19.503	<0.001	3.077	1.869~5.068
常量	-5.890	0.494	142.449	<0.001	0.000	-

指标	年龄	糖尿病	结石直径	胆总管直径	NLR	AMS	CRP
年龄	-	1.292	0.060	0.416	0.001	0.130	0.551
糖尿病	1.292	-	0.056	0.056	1.926	0.147	1.178
结石直径	0.060	0.056	-	0.086	0.394	1.113	0.676
胆总管直径	0.416	0.056	0.086	-	0.111	0.715	0.591
NLR	0.001	1.926	0.394	0.111	-	0.224	0.909
AMS	0.130	0.147	1.113	0.715	0.224	-	1.713
CRP	0.551	1.178	0.676	0.591	0.909	1.713	-