Abstract:

Objective To investigate the efficacy of bedside index for severity in acute pancreatitis（BISAP） score combined with serum soluble receptor for advanced glycation end product（sRAGE） for predicting the severity and prognosis in hyperlipidemic acute pancreatitis（HLAP）. Methods A total of 142 HLAP patients admitted to the Second Affiliated Hospital of Anhui Medical University from March 2017 to August 2022 were enrolled. The acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ），sequential organ failure assessment（SOFA） and BISAP were scored. The clinicopathologic data and clinical laboratory determination results were collected，and serum sRAGE levels were determined. The patients were classified into severe HLAP（severe group，54 cases） and non-severe HLAP（non-severe group，88 cases） according to BISAP score. According to the 30 d survival status after admission，the patients were classified into death group（42 cases） and survival group（100 cases）. Logistic regression analysis was used to evaluate the risk factors for 30 d admission death in HLAP patients. Receiver operating characteristic（ROC） curve was used to evaluate the differential diagnosis of severe HLAP and death at 30 d after admission. Results The levels of APACHEⅡ score，SOFA score and sRAGE were increased in severe group compared with non-severe group（P<0.05）. Compared with survival group，C-reactive protein（CRP），sRAGE，BISAP score≥3 points，APACHEⅡ score and SOFA score in death group were increased（P<0.05）. Multivariate Logistic regression analysis showed that increased APACHE Ⅱ score and increased sRAGE level were risk factors for severe HLAP [odds ratios（OR） were 1.17 and 1.01，95% confidence intervals（CI） were 1.03-1.34 and 1.00-1.03，respectively]. BISAP score ≥3 and serum sRAGE level were risk factors for death at 30 d after admission in HLAP patients（OR=1.99 and 1.01，95% CI 1.53-2.98 and 1.00-1.01，respectively）. The area under curve（AUC） of sRAGE for differential diagnosis of severe HLAP was 0.73. The AUC of BISAP score，sRAGE single and combined determinations for HLAP patients were 0.81，0.67 and 0.86，respectively. The AUC of CRP，SOFA score，APACHE Ⅱ score and sRAGE in the differential diagnosis of severe HLAP was 0.77. The AUC of combined determination of CRP，SOFA score，APACHEⅡ score，sRAGE and BISAP score for death in 30 d among HLAP patients after admission was 0.89. Conclusions The sRAGE plays a role in assessing HLAP severity. The combined determination of sRAGE and BISAP score can improve the assessment efficacy of short-term prognosis in HLAP.

Key words: Soluble receptor for advanced glycation end product, Bedside index for severity in acute pancreatitis score, Hyperlipidemic acute pancreatitis