| ObjectivesTo evaluate the clinical value of serum procalcitonin(PCT)in early predicting the severity of hyperlipidemic acute pancreatitis(HLAP).MethodsThe clinical data of 617 patients with HLAP hospitalized in the second hospital affiliated to Soochow University from January 2009 to June 2019 were collected,and the clinical characteristics of these HLAP patients were analyzed.Then,the included HLAP patients were grouped according to the Balthazar CT grading standard and the newly revised Atlanta classification standard in 2012.The serum PCT levels of patients in each group were collected and analyzed on the 1st,2nd,3rd,4th,5th and 6th day after onset.Kendall’s tau-b correlation was used to evaluate the correlation between serum PCT level and the severity of HLAP.The relationship between serum PCT and severe HLAP was analyzed by logistic regression.Receiver operating characteristic(ROC)curve was used to analyze the optimal threshold of serum PCT for early prediction of severe HLAP.Results(1)Analyzing the serum PCT levels of all patients with HLAP on the 1st,2nd,3rd,4th,5th and 6th day after onset,it was found that the serum PCT levels of these patients increased gradually after onset and reached the peak on the fourth day.(2)According to the Balthazar CT grading standard,the patients of HLAP were divided into mild acute pancreatitis(MAP)groups and severe acute pancreatitis(SAP)groups.Comparing and analyzing the serum PCT levels of the two groups,it was found that the serum PCT levels of MAP groups and SAP groups on the 1st,2nd,3rd,4th,5th and 6th day after onset were[(0.14±0.30),(0.18±0.39),(0.26±0.66),(0.29±0.45),(0.25±0.41),(0.14±0.15)ng/mL],[(3.49±14.49),(9.93±22.23),(9.11±21.61),(7.69±19.15),(7.05±17.65)、(3.62±11.07)ng/mL].The serum PCT levels in SAP groups was significantly higher than that in MAP groups on the 2nd,3rd and 6th day after onset(P<0.05).According to the newly revised Atlanta classification standard in 2012,the patients of HLAP were divided into MAP groups,moderately severe acute pancreatitis(MSAP)groups and SAP groups.Comparing and analyzing the serum PCT levels of the three groups,it was found that the serum PCT levels of MAP groups and SAP groups on the 1st,2nd,3rd,4th,5th and 6th day after onset were[(0.14±0.30),(0.20±0.40),(0.26±0.66),(0.30±0.44),(0.27±0.41),(0.15±0.16)ng/mL],[(0.75±1.49),(2.19±2.83),(1.60±1.48),(1.33±0.99),(1.66±1.93),(0.90±0.91)ng/mL],[(14.12±31.11),(31.78±35.55),(30.68±34.99),(22.04±30.46),(15.20±26.19),(11.28±19.95)ng/mL].The serum PCT levels in SAP groups was significantly higher than that in MSAP groups and MAP groups at the same time point,and the difference was statistically significant(P<0.05).The serum PCT levels in MSAP groups was also significantly higher than that in MAP groups at the same time point(P<0.05).(3)The results of Kendall’s tau-b related evaluation showed that no matter which classification criteria were used to group HLAP patients according to their severity,the serum PCT levels of HLAP patients on the 1st,2nd,3rd,4th,5th and 6th day after onset were positively correlated with the severity of HLAP.(P<0.05).Logistic regression analysis showed that serum PCT was an effective predictor of severe HLAP in the early stage(P<0.05).(4)Among the patients diagnosed as SAP according to Balthazar CT grading standard,the serum PCT had the highest specificity in predicting severe HLAP on the second day,and the corresponding optimal threshold was 0.51 ng/mL(sensitivity was 78.7%,specificity was 96.4%,AUC was 0.940).On the third day,the sensitivity and specificity of serum PCT were high,and the corresponding optimal threshold was 0.28 ng/mL(sensitivity was 93.5%,specificity was 87.2%,AUC was 0.949).On the fourth day,the Youden index of serum PCT was the highest,and the corresponding optimal threshold was 0.28 ng/mL(sensitivity was 98.1%,specificity was 87.5%,AUC was 0.933).Among the patients diagnosed as SAP according to the newly revised Atlanta classification standard in 2012,the Youden index of serum PCT was the highest on the second day,and the corresponding optimal threshold was 1.81 ng/mL(sensitivity was 87.5%,specificity was 87.1%,AUC was 0.927).ConclusionsThe level of serum PCT is closely related to the severity of HLAP,which is an effective early predictor of severe HLAP and has a good accuracy in predicting the severity of HLAP in the early stage. |
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