Development of a hemodynamic scoring system for acute pancreatitis: an exploratory approach to optimizing fluid resuscitation

Our study aims to establish and validate a scoring framework based on hemodynamic parameters in patients with acute pancreatitis (AP), and to evaluate its clinical predictive performance and significance in guiding fluid resuscitation. The clinical data of AP patients admitted to the ICU for the first time were extracted from the eICU 2.0 and MIMIC-IV 3.1 databases. Subjects were stratified into death and survival groups based on in-hospital outcomes. Key predictors were identified via intergroup comparison, LASSO regression, and multivariable logistic regression, and were used to develop a nomogram prediction model and a cyclic scoring system. Model performance was evaluated via receiver operating characteristic (ROC) curves, calibration plots, Hosmer–Lemeshow test, decision curve analysis, and internal and external validation. The hemodynamic scoring model was constructed by imitating the Framingham risk scoring system, and its clinical utility for fluid resuscitation was assessed via ROC analysis, box plots, and line graphs. This study included 707 patients (42 deaths and 665 survivors) from the eICU 2.0 database and 423 patients (38 deaths and 385 survivors) from the MIMIC-IV 3.1 database, all admitted to the ICU for AP. After screening, average arterial pressure (MAP), age shock index (ASI), urea nitrogen (BUN), and potassium ion (K+) were selected to construct a prediction model. The constructed scoring system was internally and externally validated using the eICU 2.0 database and MIMIC-IV 3.1 database, with an area under the curve (AUC) of 0.80 (95% CI: 0.74–0.88) and 0.81 (95% CI: 0.72–0.89), respectively. When applied to fluid resuscitation in AP patients, this model demonstrated potential utility in guiding therapy. The clinical model established based on MAP, ASI, BUN and K+ demonstrates good discriminatory power, calibration, and clinical utility in predicting the mortality rate of AP patients in the ICU. The established hemodynamic scoring system can identify high-risk AP patients and guide clinical intervention, and has potential value in guiding fluid resuscitation for AP patients in the ICU.