title: Prediction of severe acute pancreatitis using classification and regression tree analysis.
abstract: BACKGROUND
  The available prognostic scoring systems for acute pancreatitis have limitations that restrict their clinical value.
  
  
  OBJECTIVE
  To develop a decision model based on classification and regression tree (CART) analysis for the prediction of severe acute pancreatitis (SAP).
  
  
  METHODS
  A total of 420 patients with acute pancreatitis were enrolled. Study participants were randomly assigned to the training sample and test sample in a 2:1 ratio. First, univariate analysis and logistic regression analysis were used to identify predictors associated with SAP in the training sample. Then, CART analysis was carried out to develop a simple tree model for the prediction of SAP. A receiver operating characteristic (ROC) curve was constructed in order to assess the performance of the model. The prediction model was then applied to the test sample.
  
  
  RESULTS
  Four variables (systemic inflammatory response syndrome [SIRS], pleural effusion, serum calcium, and blood urea nitrogen [BUN]) were identified as important predictors of SAP by logistic regression analysis. A tree model (which consisted of pleural effusion, serum calcium, and BUN) that was developed by CART analysis was able to early identify among cohorts at high (79.03%) and low (7.80%) risk of developing SAP. The area under the ROC curve of the tree model was higher than that of the APACHE II score (0.84 vs. 0.68; P < 0.001). The predicted accuracy of the tree model was validated in the test sample with an area under the ROC curve of 0.86.
  
  
  CONCLUSIONS
  A decision tree model that consists of pleural effusion, serum calcium, and BUN may be useful for the prediction of SAP.
authors.affiliation: Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical College, No. 2, Fu Xue Road, 325000 Wenzhou, Zhejiang, People's Republic of China. hwdsci@gmail.com
authors.forename: Wandong
authors.initials: W
authors.lastname: Hong
authors.forename: Lemei
authors.initials: L
authors.lastname: Dong
authors.forename: Qingke
authors.initials: Q
authors.lastname: Huang
authors.forename: Wenzhi
authors.initials: W
authors.lastname: Wu
authors.forename: Jiansheng
authors.initials: J
authors.lastname: Wu
authors.forename: Yumin
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000145:classification* / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index