To construct a nomogram prediction model for early prediction of mortality risk in patients with non-mild acute pancreatitis (NMAP) and analyze its clinical application effect and advantages over other scoring systems.

Clinical data of 606 patients with NMAP from the large medical information mart for intensive careⅢ database (MIMIC-Ⅲ ) were selected. The patients were randomly divided into training and validation sets in a 7∶3 ratio. LASSO-Cox regression analysis was performed to construct a nomogram prediction model for mortality risk in NMAP patients. The model’s performance was assessed through receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis (DCA). Additionally, the predictive efficacy of the nomogram model was compared with BISAP, SOFA, qSOFA, APS Ⅲ, and OASIS scores.

LASSO-Cox regression analysis identified age, systolic blood pressure within 24 hours of admission, red blood cell distribution width (RDW), serum albumin, blood urea nitrogen (BUN), total bilirubin, and international normalized ratio (INR) as independent risk factors associated with mortality in NMAP patients (P<0.05). A nomogram prognostic model was developed based on these factors. The area under the curve (AUC) for the nomogram model was 0.76 (95% CI: 0.67-0.83), 0.79 (95% CI: 0.72-0.83), 0.83 (95% CI: 0.77-0.87), and 0.83 (95% CI: 0.78-0.88), respectively, for predicting mortality at 14, 30, 60, and 90 days in NMAP patients. The validation set demonstrated AUC values of 0.85 (95% CI: 0.76-0.94), 0.83 (95% CI: 0.76-0.91), 0.86 (95% CI: 0.79-0.93), and 0.87 (95% CI: 0.81-0.93), respectively. Calibration curves indicated excellent agreement between predicted and observed probabilities of mortality in both the training and validation sets. The DCA curve indicated that the nomogram had significantly positive net benefit when the threshold probability ranged from approximately 0.2 to 0.8. The ROC curve revealed superior prediction efficiency of the nomogram model compared to BISAP, SOFA, qSOFA, APSⅢ, and OASIS scores (P<0.05).

The nomogram model, incorporating age, systolic blood pressure within 24 hours of admission, RDW, serum albumin, BUN, total bilirubin, and INR offers a simple and convenient tool for accurate prediction of death risk in NMAP patients early.