Predictive Value Of GLR,RDW/SC In The Severity Of Acute Pancreatitis

OBJECTIVE: To investigate the predictive value of glucose/lymphocyte ratio(GLR),red blood cell distribution width(RDW)and serum calciumion(SC)ratio(RDW/SC)in patients with moderate-to-severe acute pancreatitis(M-SAP)(moderately severe acute pancreatitis+ severe acute pancreatitis)and related complications.METHODS: 551 patients with acute pancreatitis(AP)admitted to the Department of Gastroenterology of the Affiliated Hospital of Southwest Medical University from April 2020 to April 2022 were retrospectively collected and divided into mild(MAP)group(316 cases)and moderate-severe(M-SAP)(moderately severe acute pancreatitis + severe patients acute pancreatitis)group(235 cases)according to the 2012 Atlanta Classification;and PE(pleural fluid accumulation)(n=209)group versus non-PE(pleural fluid accumulation)(n=342)group,APFC(acute peripancreatic fluid accumulation)(n=226)group versus non-APFC(acute peripancreatic fluid accumulation)(n=325)group,ANC(acute pancreatic necrosis accumulation)(n=105)group versus non-ANC(acute pancreatic necrosis accumulation)(n=446)group,IPN(infected pancreatic necrosis)(n=83)group versus non-IPN(infected pancreatic necrosis)(n=468)group;two groups were divided according to the BISAP(Bedside Severity Index of Acute Pancreatitis)scoring system into BISAP ≥3subgroups(n=42)group and BISAP score <3(n=409)group.Basic patient information and laboratory indicators were collected,and the correlation between the indicators and the scoring system was analysed using the Spearman method;logistic regression was used to analyse the effect of GLR(quartiles Q1 to Q4 groups),RDW/SC index(quartiles q1 to q4 groups)and the combination of the two on the severity and complications of AP patients;the predictive value of GLR,RDW/SC index and their combination for moderate-severe AP and complications was evaluated using receiver operating characteristic(ROC)curves.Results: 1.patients in the M-SAP group had higher age,WBC,NEU,MONO,RDW,FPG,AST,GLR,RDW/SC,BISAP score,proportion of hypertensive history,length of stay,PE,APFC,IPN,ANC than the MAP group,and lower LYM,ALB,SC,SS than the MAP group(p< 0.05).while the differences in gender,proportion of history of diabetes mellitus,proportion of fatty liver disease,proportion of history of smoking,proportion of history of alcohol consumption,PLT,TG,HDL-C and ALT between the 2 groups were not statistically significant(p > 0.05).2.Binary logistic regression analysis showed that before correcting for variables,the risk of M-SAP was higher in quartiles 3 and 4 of GLR than in quartile 1(p < 0.05),and the difference between quartile 2 and quartile 1 was not statistically significant(p > 0.05),while the risk of M-SAP in quartiles 2,3and 4 of RDW/SC was higher than in quartile 1 risk was higher in all quartile 1groups(p < 0.05),after correcting for age,length of stay,sex(Male = 1,Female= 0),history of smoking(yes = 1,no = 0),history of alcohol consumption(yes= 1,no = 0),fatty liver(yes = 1,no = 0),diabetes(yes = 1,no = 0),WBC,NEU,LYM,MONO,RDW,PLT,ALT,AST ALB,SS,FPG,SC,the risk of M-SAP was higher in quartiles 3 and 4 of RDW/SC and GLR than in quartile 1(p <0.05),and the difference between quartile 2 and quartile 1 was not statistically significant(p> 0.05);the AUCs for GLR,RDW/SC and the combination of the two to predict M-SAP were 0.696,0.696,0.692 and 0.758 for GLR,RDW/SC and their combined prediction of M-SAP,respectively,and their combined prediction of M-SAP was greater than their predictive value alone,and the differences were statistically significant.The sensitivity of GLR,RDW/SC and the combination of the two in predicting M-SAP were 0.694,0.672 and 0.753,respectively;the specificity of GLR,RDW/SC and the combination of the two in predicting M-SAP were 0.648,0.623 and 0.633,respectively.3.Binary logistic regression analysis showed that: the risk of concurrent PE,APFC and ANC was higher in q3 and q4 groups than in q1 group(p < 0.05),and the difference between q2 and q1 groups was not statistically significant(p > 0.05);the risk of concurrent IPN was higher in q4 group than in q1 group(p < 0.05),and there was no statistical significance between q2 and q3 group and q1 group(p> 0.05).The risk of concurrent PE,APFC,IPN and ANC was higher in groups Q3 and Q4 than in group Q1(p < 0.05),but the difference between groups Q2 and Q1 was not statistically significant(p > 0.05);the AUCs of GLR,RDW/SC and the combination of the two for predicting PE were 0.607,0.681 and 0.701,respectively;the AUCs of GLR,RDW/SC and the combination of the two for predicting APFC were 0.639,0.657,and 0.704respectively;the AUCs of GLR,RDW/SC and the combination of the two for predicting ANC were 0.641,0.683,and 0.724 respectively;the AUCs of GLR,RDW/SC and the combination of the two foe predicting IPN were 0.617,0.660,and respectively.4.positive correlations(p < 0.05)between GLR,RDW/SC and both the Atlanta Classification and the BISAP scoring system.Conclusions:GLR and RDW/SC have some diagnostic value for both M-SAP and complications,and the combination of the two can improve the predictive efficacy of diagnosing M-SAP and complications.