Abstract: Objective To construct a nursing early warning model for acute pancreatitis based on simple bedside indicators, to make validation and to discuss its predictive value when the disease condition changes. Methods We conducted a retrospective study with data of 378 acute pancreatitis cases from a tertiary grade-A Hospital in Guangdong. Cases were categorized into the training set (n=244) and further subdivided into severe acute pancreatitis cases and non-severe cases; the remaining cases were categorized into the validation set (n=134). Risk factors in the validation set and two non-severe groups in the training set were comparatively analyzed. Logistic regression analysis was adopted to construct a warning model. The area under the receiver operating characteristic curve (ROC-AUC) was calculated to test the discrimination of the model, and Hosmer-Lemeshow goodness-of-fit test was performed to test the accuracy. The validation set was used to test the warning performance of the model, which was compared with the BISAP and APACHE II scoring methods. Results Seven indicators were identified and included in the warning model, including heart rate (OR=1.040), respiratory (OR=1.269), pulse oxygen saturation (OR=0.824), weak bowel sounds (OR=2.383), disappearance of bowel sounds (OR=3.227), pulmonary auscultation (OR=2.185) and peritoneal irritation (OR=2.097). the p-value in Hosmer-Lemeshow goodness-of-fit test was 0.278. ROC-AUC was 0.840 (95%CI:0.788~0.892,P<0.001); maximized Youden index 0.541, sensitivity 68.3% and specificity 85.8%. In the validation set, the ROC-AUC was 0.802(95%CI:0.714~0.891,P<0.001), and maximized Youden index 0.605. The sensitivity (70.5% vs 84.1% vs 79.5%) and accuracy (78.4% vs 85.1% vs 82.1%) were lower than those by BISAP and APACHE II scoring methods, while the specificity was higher (90.0% vs 84.4% vs 83.3%). Conclusion The model in the study is easy to establish and convenient and exhibits good performance equivalent to the recognized BISAP and APACHE II scores in predicting acute pancreatitis severity. It also shows advantages in rapid bedside evaluation, and can be a supplement to evaluation system of acute pancreatitis.

Key words: acute pancreatitis, warning model, rapid bedside care, nursing