Acute pancreatitis (AP) has heterogeneous clinical features, and identifying clinically relevant sub-phenotypes is useful. We aimed to identify novel sub-phenotypes in hospitalized AP patients using longitudinal total serum calcium (TSC) trajectories. AP patients had at least two TSC measurements during the first 24 h of hospitalization in the US-based critical care database (Medical Information Mart for Intensive Care-III (MIMIC-III) and MIMIC-IV were included. Group-based trajectory modeling was used to identify calcium trajectory phenotypes, and patient characteristics and treatment outcomes were compared between the phenotypes. A total of 4518 admissions were included in the analysis. Four TSC trajectory groups were identified: “Very low TSC, slow resolvers” (n = 65; 1.4% of the cohort); “Moderately low TSC” (n = 559; 12.4%); “Stable normal-calcium” (n = 3875; 85.8%); and “Fluctuating high TSC” (n = 19; 0.4%). The “Very low TSC, slow resolvers” had the lowest initial, maximum, minimum, and mean TSC, and highest SOFA score, creatinine and glucose level. In contrast, the “Stable normal-calcium” had the fewest ICU admission, antibiotic use, intubation and renal replace treatment. In adjusted analysis, significantly higher in-hospital mortality was noted among “Very low TSC, slow resolvers” (odds ratio [OR], 7.2; 95% CI, 3.7 to 14.0), “moderately low TSC” (OR, 5.0; 95% CI, 3.8 to 6.7), and “Fluctuating high TSC” (OR, 5.6; 95% CI, 1.5 to 20.6) compared with the “Stable normal-calcium” group. We identified four novel sub-phenotypes of patients with AP, with significant variability in clinical outcomes. Not only the absolute TSC levels but also their trajectories were significantly associated with in-hospital mortality.

中文翻译：

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使用总血清钙轨迹识别新的急性胰腺炎亚表型

急性胰腺炎（AP）具有异质性的临床特征，识别临床相关的亚表型是有用的。我们的目的是利用纵向总血清钙 (TSC) 轨迹来识别住院 AP 患者的新亚表型。在美国重症监护数据库（包括重症监护医疗信息集市-III (MIMIC-III) 和 MIMIC-IV）中，AP 患者在住院的前 24 小时内至少进行了两次 TSC 测量。基于组的轨迹建模用于识别钙轨迹表型，并对不同表型之间的患者特征和治疗结果进行了比较。分析中总共纳入了 4518 名入院患者：“TSC 极低，解决者缓慢”（n = 65； 1.4% 的人群）；“TSC 中度偏低”（n = 559；12.4%）；“钙含量稳定正常”（n = 3875；85.8%）；以及“TSC 波动较高”（n = 19；0.4%） “非常低的 TSC，缓慢的解决者”具有最低的初始、最大、最小和平均 TSC，以及最高的 SOFA 评分、肌酐和血糖水平，相比之下，“稳定的正常钙”的 ICU 入院率、抗生素最少。在调整分析中，“TSC 极低、分解速度慢”的患者院内死亡率显着较高（比值比 [OR]，7.2；与对照组相比，95% CI，3.7 至 14.0）、“中度低 TSC”（OR，5.0；95% CI，3.8 至 6.7）和“波动高 TSC”（OR，5.6；95% CI，1.5 至 20.6） “稳定正常钙”组。我们确定了 AP 患者的四种新亚表型，其临床结果存在显着差异。不仅 TSC 绝对水平及其轨迹与院内死亡率显着相关。