| Objective:To explore the value of neutrophils-lymphocytes ratio(NLR)and Systemic inflammatory Response Syndrome(SIRS)for early prediction of the severity of acute pancreatitis(AP),and to compare Analyze the predictive power of both.Method : A retrospective analysis of the general data(age,gender,etiology,height,weight),vital signs(body temperature,breathing,heart rate)and laboratory test results(White blood cell count,neutrophil count,lymphocyte count,urea nitrogen,serum creatinine,blood calcium,lactate dehydrogenase)of 149 patients hospitalized with AP for the first time from March 2016 to October 2018.Calculating the NLR and SIRS score of each patient.AP patients were divided into mild acute pancreatitis(MAP)group and severe acute pancreatitis(SAP)group,SIRS group and non-SIRS group.The variation of NLR at three points in time between the two groups of MAP and SAP were analyzed by repeated measures analysis of variance.The correlation of NLR and SIRS scores with AP severity was analyzed using binary logistic regression.The accuracy of the prediction of AP severity by NLR and SIRS scores of the above three points was analyzed using the area under receiver operating characteristic(AUC of the ROC),sensitivity,specificity,Positive predictive value(PPV),negative predictive value(NPV),and the AUC of NLR and SIRS scores at the3 time points were compared and analyzed by Medcalcl 19.2 software.Result:(1)The differences of blood creatinine,urea nitrogen,serum blood calcium,serum albumin,and lactate dehydrogenase between the MAP group and the SAP group were statistically significant(P <0.001).Compared with the MAP group,the blood calcium and serum albumin were lower.Serum creatinine,lactate dehydrogenase,and serum albumin are independent risk factors for SAP.(2)The M(Q)of NLR which the three point in time from the patients at MAP group was 5.46(3.80),4.70(3.29)and 4.11(3.33),but in the SAP group,The M(Q)of NLR was 9.86(7.37),8.72(6.52)and 8.29(5.29),The difference is statistically significant(P<0.05).There were statistically significant differences in NLR between the MAP group and the SAP group at these three different time points(F(2,146)=35.870,P<0.001).The AUC under the ROC curve of the NLR predicted SAP at admission,24 h and 48 h after admission were:0.805(95%CI:0.728-0.883),0.779(95%CI:0.702-0.855),0.827(95%CI :0.759-0.896).The critical value,sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of SAP predicted by NLR at admission,24 h after admission,and 48 h after admission were: 8.74,66.7%,79.8%,58.8%,84.7%;7.02,60.7%,76.9%,51.9%,84.2%;5.70,75.6%,72.1%,50.8%,87.2%.(3)The AUC of At admission,24 h after admission,and 48 h after admission SIRS scores predicted SAP were: AUC=0.691(95%CI:0.595-0.787),AUC=0.736(95%CI:0.643-0.829),AUC=0.752(95%CI:0.660-0.843),the predicted sensitivity,specificity,PPV and NPV were: 62.2%,76.0%,52.8%,82.3%;64.4%,82.7%,61.7%,84.3%,;66.7%,83.7%,63.8%,85.3%(4)The NLR and SIRS scores of AP patients after admission at the above three different times predict the area under the ROC curve of SAP in order:NLR at 48 h after admission>NLR at admission>NLR at 24 h after admission>SIRS score at 48 h after admission>SIRS score at 24 h after admission>admission SIRS score.Conclusion:(1)NLR and SIRS scores are reliable indicators for early prediction of SAP(2)The critical value of NLR prediction of SAP is inconsistent at different times during admission and needs to be dynamically evaluated(3)The accuracy of NLR’s prediction of SAP is higher than the SIRS score. |
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