| Objective:Acute pancreatitis is an acute systemic inflammatory disease caused by a variety of causes,and it is a common acute abdominal disease in clinical practice.The etiology and pathogenesis of acute pancreatitis are still not very clear.In recent years,the incidence of acute pancreatitis has increased gradually,and the mortality rate has remained high,especially for severe acute pancreatitis.At present,a variety of scoring systems and serum markers have been used for the assessment and prediction of the severity of acute pancreatitis,but due to various reasons,The practical application of them is limited.Early detection of markers that are suggestive of disease progression and prognosis is particularly important for early warning to improve the therapeutic effect of disease and to improve the prognosis and survival rate of patients.The study was to explore the early evaluative value of neutrophil-lymphocyte ratio alone and combined with other markers(creatinine,urea nitrogen,blood calcium)for the severity of acute pancreatitis,and to provide a reference for early warning of severe acute pancreatitis.Methods:The clinical data of 666 patients with acute pancreatitis who were admitted to the Department of Hepatobiliary and Pancreatic Surgery from January 2012 to December 2018 were retrospectively collected,and the neutrophil-lymphocyte ratio(NLR)of each patient was calculated.According to the 2012 classification standard for acute pancreatitis in Atlanta,the patients were divided into severe acute pancreatitis group and non-severe acute pancreatitis group.The data were analyzed by SPSS 24.0,comparing the general conditions,laboratory indicators and NLR values of the two groups with statistical differences.Logistic regression analysis and receiver operating characteristic curve were used to analyze the evaluative value of NLR alone and in combination with other markers for the severity of acute pancreatitis,and the consistency analysis was performed using Kappa test and goldstandard.Results:(1)There were 104 patients in the severe acute pancreatitis group,including 41 cases of male(39.4%)and 63 cases of female(60.6%),whose ages ranged from 16 years old to 86 years old,with an average age of 46.7±14.9 years.There were 562 patients in the non-severe acute pancreatitis group,of which 206 were males(36.7%)and 356 were females(63.3%).The ages ranged from 14 years old to 88 years old,with an average age of 43.7±14.0years.There was no statistically significant difference in the distribution of age and sex between the two groups(P >0.05),and there was no significant difference in the composition ratio of smoking history,drinking history,diabetes history,and hypertension history between the two groups(P >0.05).(2)The leucocyte,neutrophil,monocyte,NLR,aspartate aminotransferase,direct bilirubin,total bile acid,serum creatinine,urea nitrogen,triglyceride and fasting blood glucose levels of patients in the severe acute pancreatitis group were significantly higher than those in the non-severe acute pancreatitis group(P < 0.05).However,the lymphocyte absolute value,platelet,alkaline phosphatase,albumin,cholesterol and serum calcium levels of the severe acute pancreatitis group were significantly lower than those of the non-severe acute pancreatitis group(P <0.05).(3)The areas under the ROC curve of NLR,creatinine,blood calcium,and urea nitrogen separately evaluating the severity of acute pancreatitis were 0.728(95% CI: 0.680-0.776,P<0.01),0.739(95% CI: 0.673-0.805,P <0.01),0.772(0.717-0.827,P <0.01),0.762(95% CI:0.703-0.820,P <0.01),and the optimal critical values are 5.455,88.6mmol/L,1.975mmol/ L,7.095mmol/L,respectively.The sensitivity was 86.5%,57.7%,53.8%,55.8%,and the specificity was 51.6%,93.1%,89.7%,90.7%,respectively.The positive predictive values were 24.9%,60.6%,49.1%,and 52.7%,respectively.The negative predictive values were95.4%,92.3%,91.3% and 91.7%,respectively,and the Kappa values were 0.190,0.518,0.419 and 0.454,respectively.The area under the ROC curve of serum calcium was the largest(0.772),the sensitivity of NLR was the highest(86.5%),but the consistency was poor,and the specificity of creatinine was the highest(93.1%)and the consistency was the best.(4)The area under the ROC curve to evaluate the severity of acute pancreatitis by NLR combined with creatinine,blood calcium and urea nitrogen was 0.835(95%CI: 0.786-0.885,P <0.01),0.823(95%CI: 0.776-0.869,P <0.01),and 0.845(95%CI:0.802-0.887,P <0.01).In general,the area under the ROC curve evaluated by combining NLR with other markers was larger than that evaluated by each marker alone.The area under the ROC curve evaluated by combining NLR with urea nitrogen was the largest(0.845).(5)The sensitivity of NLR to evaluate the severity of acute pancreatitis in tandem with creatinine,blood calcium,and urea nitrogen was 49.0%,47.1%,and 46.2%,the specificities were 96.3%,92.9%,and 94.0%,respectively.The positive predictive values were 70.8 %,55.1%,58.5%,negative predictive values were 91.1%,90.5%,90.4%,and Kappa values were 0.518,0.425,and 0.439,respectively.The sensitivity of NLR to evaluate the severity of acute pancreatitis was 95.2%,93.3%,and 96.2%,and the specificities were 48.4%,48.4%,and 48.4%,respectively.The positive predictive values were 25.4%,25.1% and 25.6%,The negative predictive values were 98.2%,97.5%,and 98.6%,and the Kappa values were 0.206,0.198,and 0.210,respectively.NLR and urea nitrogen have the highest sensitivity(96.2%)when tested in parallel,and the specificity is 92.9% when tested in series,and the highest specificity(96.3%)when NLR is compared with creatinine in series,and the parallel comparison sensitivity is also higher(95.2 %).Conclusions:(1)NLR can be used as one of the indicators to evaluate the severity of acute pancreatitis at an early stage,and it is positively correlated with the severity of acute pancreatitis.The higher the NLR value,the more severe the condition.(2)Compared with creatinine,blood calcium,and urea nitrogen,the sensitivity of NLR to evaluate the severity of acute pancreatitis is higher.The sensitivity is 86.5% and the specificity is 51.6% when the optimal cutoff is 5.455.(3)Compared with the single index of NLR,NLR combined with creatinine,urea nitrogen,and blood calcium is more valuable for early evaluation of the severity of acute pancreatitis.And among the three combined tests,NLR combined with urea nitrogen has the best evaluation effect. |
PDF Full Text Request