Prognostic nomogram for acute pancreatitis patients: An analysis of publicly electronic healthcare records in intensive care unit

Purpose: The mortality rate of severe acute pancreatitis (AP) is 20-30% even after admission to intensive care unit (ICU). Thus we aimed to develop a laboratory-based nomogram to identify AP patients at high risk for mortality.

Materials and methods: The primary and validation cohorts were extracted from the Medical Information Mart for Intensive Care III database (MIMIC-III). Independent predictors were determined using multiple Cox analysis and then assembled to predict survival. The performance of proposed nomogram was evaluated by Harrell's concordance index (C-index) and area under the receiver operating characteristic (AUC) analysis, and subsequently compared with conventional scoring systems.

Results: A total of 342 AP patients admitted to ICU were enrolled, with 30-day, 180-day and 1-year mortality rate of 10.8%, 16.1% and 17.5%, respectively. Independent factors from multivariate Cox model to prognosticate 30-day and 1-year mortality were retrieved. The C-index of 1-year prediction nomogram (0.758, 95%CI: 0.676-0.840) were superior to several prediction approaches, and these findings were further confirmed by applying time-specific AUC analysis. Decision curve analysis indicated our nomogram was feasible in clinical practice. Similar results were observed in the validation cohort.

Conclusions: The proposed nomogram gives rise to accurately prognostic prediction for critically AP patients admitted to ICU.