Serum soluble endorphin combined with BISAP score predicts severe acute pancreatitis combined with septic shock

General information

The sample size required for the study was calculated by G-power, and α=0.05 and β=0.05 were selected to formulate the test level α and test efficacy 1-β. The effect size was selected as 0.5, the sample size of a single group was calculated to be 105, and the total sample size was predicted to be 111 cases considering that 5 % of the samples might be lost to visit and so on. Finally, 130 patients with SPA complicated with sepsis were included in the present study. A total of 130 cases of SAP complicated with sepsis admitted to Anhua Peoples Hospital from January 2019 to June 2023 were selected, all of which met the diagnostic criteria for SAP and sepsis [2], 12].

Exclusion criteria: Patients with a recent history of anticoagulation or thrombolytic therapy; patients with organic lesions such as heart, liver and kidney; patients with glucocorticosteroids or other immune function-affecting drugs in the 14 days prior to admission; patients with multiple traumas and massive blood loss; patients with psychiatric disorders.

Among the 130 cases of SAP complicated with sepsis, there were 86 males and 44 females; their ages were from 23 to 64 years old (40.86 ± 10.53); body mass index was from 20.0 to 28.8 (23.94 ± 2.06) kg/m². Patients were divided into two groups according to whether septic shock occurred or not, namely the group without shock (88 cases) and the group with shock (42 cases). All patients were followed up for a period of 30 days. The patients were categorized into survival group (102 patients) and death group (28 patients) according to the outcome of follow-up. The study was executed with the approval and consent of the Medical Ethics Committee of Anhua Peoples Hospital, and the patients and/or their families signed the relevant informed consent forms.

Diagnostic criteria for septic shock

Diagnostic criteria: 1) Clinical manifestations of infection, laboratory evidence (e.g., increased PCT) or imaging evidence. 2) SOFA score ≥2; 3) persistent hypotension despite adequate fluid resuscitation, requirement of antihypertensive drugs to maintain mean arterial pressure above 8.65 kPa, and blood lactate above 2 mmol/L [7].

Research methods

General data such as gender, age, underlying diseases, and triggers of SAP were collected from all included patients. The patients were scored using the APACHEII and SOFA scale to assess the severity of the disease. An APACHEII score of >17 was classified as a severe disease, and the score was positively correlated with the severity of the disease. The SOFA score ranges from 0 to 24, with the higher score suggesting the more severe the condition and the worse the prognosis [13]. BISAP was calculated.

Fasting peripheral venous blood (6 mL) was collected from patients early in the morning of the day after admission, and the serum was separated after centrifugation. Blood amylase and ALT were measured by enzyme-linked immunosorbent assay kits (Sangon, Shanghai, China). CRP was measured by immunoturbidimetric assay kits (BioLab, Beijing, China). TNF-α and IL-6 were determined by radioimmunoassay kits (Multi Science, Hangzhou, China).

Statistical methods

All data were processed and analyzed by SPSS 22.0 statistical software. Enumeration data were expressed as percentages, and differences between groups were compared by the χ² test. Measurement data were expressed as mean ± standard deviation after normal test, and differences between groups were compared by the t-test. Skewed-distributed measurement data were expressed as medians (25th–75th percentiles) and compared by the Mann-Whitney U test. Post hoc tests (Bonferroni correction) were performed. Multifactorial logistic regression analysis was applied to explore the factors influencing the occurrence of septic shock in patients with SAP. Spearman’s correlation analysis was applied to explore the correlation between sENG levels, BISAP scores, APACHEII, and SOFA scores. ROC curves and the areas under the curve (AUC) were used to explore the value of sENG and BISAP score in the diagnosis of SAP complicated with septic shock. MedCalc software was utilized to compare whether there was a statistical difference in AUC between the different indexes. A p-value <0.05 was considered statistically significant.

General information

The APACHEII score, SOFA score, BISAP score, and sENG level of the group that developed shock were higher than that of the group that did not develop shock (p<0.01). There was no statistically significant difference (p>0.05) in the comparison of biochemical indexes such as gender, age, BMI, underlying diseases, triggers of disease, ALT, and blood amylase between the two groups (Table 1).

Analysis of factors affecting the occurrence of septic shock in SAP

Multifactorial logistic regression analysis was performed using whether sepsis occurred in SAP patients as the dependent variable (not occurring was assigned a value of 0, and occurring was assigned a value of 1), age as the correction variable, and indicators with statistically significant differences in Table 1 (original values were entered) as the independent variables. The results showed that APACHEII, SOFA score, BISAP score, and sENG were independent risk factors for septic shock in patients with SAP (p<0.05) (Table 2).

Correlation between sENG levels, BISAP scores, APACHEII scores, and SOFA scores in patients with SAP complicated with sepsis

Spearman correlation analysis showed a positive correlation between the sENG levels and BISAP scores, APACHEII and SOFA scores in patients with SAP complicated with sepsis (p<0.001), and BISAP score was also positively correlated with APACHEII and SOFA scores (p<0.001) (Figure 1).

Figure 1:

Correlation analysis between sENG levels and BISAP scores, APACHEII scores, and SOFA scores. Correlation analysis between BISAP scores and APACHEII scores and SOFA scores.

Value of sENG level, BISAP score alone and the combination of the two in diagnosing SAP complicated with septic shock

The results of ROC analysis showed that the cut-off values of sENG level and BISAP score for the diagnosis of SAP complicated with septic shock were sENG=13.32 ng/mL and BISAP score=2.5, with the AUC of 0.723 and 0.703 in that order. In addition, the combination of the two had the highest value for the diagnosis of SAP complicated with septic shock, with an AUC of =0.838, as shown in Table 3, Figure 2.

Figure 2:

ROC curves of sENG levels and BISAP scores for predicting septic shock in SAP patients.

Prognostic value of sENG level, BISAP score alone and both combined in assessing SAP complicated with septic shock after 30 days

The sENG level and BISAP score of patients in the poor prognosis group were higher than those in the good prognosis group (p<0.05, Table 4). The ROC curve analysis showed that the cut-off values of the sENG level and the BISAP score for predicting the prognosis of the patients with SAP complicated with septic shock were sENG=13.13 ng/mL and BISAP score=2.5, respectively. The AUC values were 0.757 and 0.706, in that order, with the highest value (AUC=0.796) of the combination of the two for diagnosing SAP complicated with septic shock, as shown in Table 5 and Figure 3.

Figure 3:

ROC curves of sENG levels and BISAP scores predicting prognosis in SAP complicated by septic shock.