Clinical Study Of Thyroid Hormone Combined With Inflammatory Factors In Predicting Prognosis Of Acute Pancreatitis

Background Acute pancreatitis(AP)is an emergency acute abdominal disease,and as inflammatory factors release the possible progression of acute pancreatitis(SIRS),a disease that triggers systemic inflammatory response syndrome(SIRS),multiple organ failure(SIRS),sepsis,etc.The rapid assessment of the severity of the AP helps to identify the stages of the disease and the risk of possible occurrence,which is critical to assessing the patient’s prognosis and the appropriate treatment.Free triiodine thyroxine(FT3)is closely related to the inflammatory response,and further assess the correlation between its and acute pancreatitis.Changes in thyroid hormones cause changes in inflammatory factors,in order to further enhance the accuracy and sensitivity of the evaluation,the further joint inflammatory factor is evaluated according to the practicability of clinical operation.Objective The aim of this study was to investigate the level of FT3 in patients with acute pancreatitis.Early warning signals of inflammation include interleukin-6(IL-6)and interleukin-10(IL-10),and the correlation between FT3 level and disease severity.Methods Data collection: A total of 312 AP patients(n=312)who met the requirements and were admitted to The Affiliated Hospital of Qingdao University from December 2019 to December 2020 were collected.They were divided into SAP groups(n=92)and non-SAP groups(n=220)according to the Atlanta Revision classification.Diagnosis and classification criteria: AP diagnosis and classification criteria are in line with Chinese Guidelines for diagnosis and Treatment of Acute Pancreatitis(2019,Shenyang).Diagnostic criteria :(1)acute,sudden,persistent,severe epigastric pain,radiating to the back;(2)Serum amylase and/or lipase activities were at least 3 times higher than the normal upper limit;(3)Enhanced CT or MRI showed typical AP imaging changes(pancreatic edema or peripancreatic effusion).If 2 of the 3 criteria are met clinically,AP can be diagnosed.Further classification:(1)MAP: meet AP diagnostic criteria,without organ failure and local or systemic complications;(2)MSAP: with transient organ failure(which can be recovered within 48 hours),or with local or systemic complications;(3)SAP: persistent organ failure(>48 h),improved Marshall score ≥2 points.According to the current research,the mortality rate of SAP is significantly different from that of other groups,which is further adjusted into SAP group and non-SAP group.Exclusion criteria :(1)prior history of hypothyroidism or hyperthyroidism diagnosed before admission;(2)pancreatitis caused by surgery,trauma and chemotherapy;(3)pregnancy;(4)chronic pancreatitis;(5)Referrals from other hospitals.Data collection: Blood or tissue samples and baseline clinical features were collected and recorded,and the APACHE ⅱ score and Ranson score were performed.Statistical analysis: t-test and chi-square test were used to evaluate the differences between the two groups.Multivariate logistic regression analysis and receiver operating characteristic(ROC)curves were used to analyze protective factors.One-way repeated measures ANOVA was used to evaluate the prognosis of SAP patients.Results Baseline characteristics: There were no significant differences in age,gender,BMI,PLT,Cr,smoking history,TSH,platelet,mean arterial pressure(P > 0.05).Etiology,history of alcohol consumption,FT3,FT4,LDH,platelet(48 h),total bilirubin,total bilirubin(48 h),creatinine(48 h),oxygenation index,oxygenation index(48 h),mean arterial pressure(48 h),CRP,PCT,white blood cell,IL-10,IL-1β,IL-2,IL-4,IL There were significant differences in-5,IL-6,IL-8,GCS score,GCS score(48 hours),SOFA score,SOFA score(48 hours),APACHE ⅱ score and Ranson score(P < 0.05).Predictive model compared with APACHE II score(AUC 0.829 [95% CI 0.769-0.889])and Ranson score(AUC 0.629 [95%CI 0.542-0.715]),predictive model(AUC 0.918 [95% CI 0.875-0.961])Serious outcomes were better predicted.The change of FT3 level in SAP group was significantly correlated with prognosis(P<0.05).Conclusions The predictive model can improve the diagnostic accuracy and prediction of the severity of disease.FT3 level could be used as an independent risk factor to predict the mortality of SAP patients.