Shi PN, Song ZZ, He XN, Hong JM. Evaluation of scoring systems and hematological parameters in the severity stratification of early-phase acute pancreatitis. World J Gastroenterol 2025; 31(15): 105236 [PMID: 40309234 DOI: 10.3748/wjg.v31.i15.105236]
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April 20, 2025, 11:47
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Reader Comments:
This study addresses a critical gap in acute pancreatitis management by systematically comparing established scoring systems with novel hematological markers. The focus on early-phase severity stratification aligns with clinical urgency, as delayed interventions in severe AP significantly worsen outcomes.
The inclusion of 463 patients across severity categories provides sufficient statistical power. The use of multivariate logistic regression to identify independent predictors and AUC comparisons for ROC analyses strengthens validity. Notably, the combined PNI48 + Ranson model achieved an AUC of 0.936, outperforming individual parameters.
However, the study has several issues that need to be addressed. 1) While CTSI showed the highest individual AUC, its reliance on CT imaging (performed 2–5 days post-admission) limits utility in hyperacute settings. The BISAP score’s superiority over APACHE II/SOFA within 24 h is consistent with prior literature , but the lack of comparison with newer tools is a missed opportunity. 2) The study’s retrospective nature introduces risks of selection bias, particularly in excluding patients with brief hospital stays (<48 h), who may represent early mortality or rapid recovery cases. External validation using multicenter cohorts is essential to confirm generalizability. 3) Most parameters (e.g., CRP48, PNI48) were assessed at fixed intervals. Dynamic trends in markers like CRP or calcium—critical for real-time clinical decision-making—were overlooked. Serial measurements could enhance predictive accuracy, as shown in studies of procalcitonin kinetics.
In conclusion, this study provides valuable insights into a multimodal approach for AP severity prediction, with PNI48 emerging as a novel, nutrition-centric biomarker. However, its retrospective design and limited temporal resolution restrict immediate clinical applicability. Methodological refinements and external validation will be critical to translate these findings into practice.
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Reader's ID:
08478088
Submitted on:
April 20, 2025, 11:04
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Reader Comment Standards for Published Articles:
1 Title
Does the title reflect the main subject/hypothesis of the manuscript?
2 Abstract
Does the abstract summarize and reflect the work described in the manuscript?
3 Key Words
Do the key words reflect the focus of the manuscript?
4 Background
Does the manuscript adequately describe the background, present status and significance of the study?
5 Methods
Does the manuscript describe methods (e.g., experiments, data analysis, surveys, and clinical trials, etc.) in adequate detail?
6 Results
Are the research objectives achieved by the experiments used in this study?
Has the study made meaningful contributions towards research progress in this field?
7 Discussion
Does the manuscript interpret the findings adequately and appropriately, highlighting the key points concisely, clearly and logically?
Are the findings and their applicability/relevance to the literature stated in a clear and definite manner?
Is the Discussion accurate and does it discuss the paper’s scientific significance and/or relevance to clinical practice sufficiently?
8 Illustrations and Tables
Are the figures, diagrams and tables sufficient, good quality and appropriately illustrative of the paper contents?
Do figures require labeling with arrows, asterisks, etc., or better legends?
9 Biostatistics
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10 Units
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11 References
Does the manuscript appropriately cite the latest, important and authoritative references in the Introduction and Discussion sections?
Does the author self-cite, omit, incorrectly cite and/or over-cite references?
12 Quality of manuscript organization and presentation
Is the manuscript concisely and coherently organized and presented?
Are the style, language and grammar accurate and appropriate?
13 Ethics statements
For all manuscripts involving human studies and/or animal experiments, author(s) must submit the related formal ethics documents that were reviewed and approved by their local ethical review committee. Did the manuscript meet the requirements of ethics?
Scientific Quality:
The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories
Language Quality:
Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.
Reader Comments:
This article presents a series of clinically practical and easily obtainable diagnostic indices, enabling medical professionals to more accurately evaluate patient conditions in real-world clinical settings. These indicators are particularly valuable for the early diagnosis and severity assessment of pancreatitis, offering crucial guidance for subsequent treatment decisions. By incorporating these measurable parameters into routine clinical practice, healthcare providers can enhance diagnostic efficiency, improve risk stratification, and facilitate timely therapeutic interventions. The systematic application of these indices not only supports evidence-based medical decision-making but also contributes to standardized patient management protocols, ultimately leading to better clinical outcomes in pancreatitis care.
Reply from the Editorial Office:
Thank you very much for your comments.