To establish a model to predict in-hospital mortality of patients with severe acute pancreatitis undergoing minimally invasive procedure including percutaneous nephrolithotomy.

Patients diagnosed with acute severe pancreatitis during Jan. 2015 till Dec. 2019 at the Pancreatitis Specialized Center were retrospectively analyzed. A total of 314 patients were included, 225 male and 89 female, median age 45.8 years old (16, 84), and median body mass index 24.26 kg/m² (14.88, 52.08). A surgical step-up approach for pancreatic necrosis or infected necrosis was implemented. The minimally invasive intervention, such as percutaneous puncture and drainage, is preferred. The decision was made whether perform percutaneous nephroscope or open surgery according to the degree of remission. Logistic regression analysis was used to evaluate the association between in-hospital mortality and relevant factors. Significant predictors of in-hospital mortality on univariate analysis (P<0.1) were entered into a stepwise selection using the Akaike information criterion to define the final model.

Of the 314 patients with severe acute pancreatitis, 44 cases (14.0%) died. In stepwise selection, the following factors were identified as predictors of in-hospital mortality: age over 60 (OR=4.01, P=0.004), multiple organ support (OR= 26.56, P<0.010), ICU stay longer than 2 d(OR=2.38, P= 0.162) and minimal invasive surgery after admission (OR= 0.17, P<0.010). The prognostic nomogram based on this model yielded a probability of in-hospital mortality ranging from <5% (0 factors) to >90% (all 4 factors).

This prediction model can accurately predict in-hospital mortality in patients with severe acute pancreatitis including those who undergoing step-up minimally invasive approach including percutaneous nephrolithotomy.