The Study Of Early Predictive Value Of Plasma Soluble Urokinase-type Plasminogen Activator Receptor In The Severity Of Acute Pancreatitis And The Establishment Of Prediction Model

BackgroundAcute pancreatitis（AP）is an acute inflammatory injury of the pancreas caused by various etiologies,and it is one of the most common digestive system diseases in the emergency department.Most patients have mild disease and a good prognosis,but about 10%of patients can progress to severe acute pancreatitis（SAP）with severe persistent organ failure and poor prognosis.The existing methods for predicting the severity of AP include multi-factor scoring systems,imaging examinations,and serum biomarkers,but the clinical applications have their limitations.Therefore,exploring novel biomarkers that can effectively predict AP severity and identify SAP risk early is of great significance for optimizing clinical treatment and improving the prognosis of SAP patients.The plasma level of su PAR reflects the activation degree of the immune system.Studies have shown that plasma su PAR levels are increased in various diseases,such as pathogen infection and aseptic inflammation,and are closely related to the prognosis of the disease.AP is characterized by a local pancreatic inflammatory response and systemic immune system activation as an inflammatory disease.Whether su PAR can be used as an early predictor of AP severity is worth exploring.Therefore,this study intends to explore the early predictive value of su PAR levels in AP severity assessment by analyzing the relationship between the plasma su PAR level when admitted to the hospital and the severity of the disease during hospitalization in AP patients.Based on the study,an early prediction model for the severity of AP patients was built to provide clinicians with a valuable method for early assessment of the severe risk of AP patients to benefit AP patients..MethodsA prospective cohort study that includes AP patients admitted to our department from March 1 to June 1,2021,was designed.When admitted to the hospital,the peripheral blood of the patients was collected to detect their su PAR levels.The general clinical data,biochemical indexes such as procalcitonin（PCT）,C-reactive protein（CRP）,interleukin-6（IL-6）and imaging examinations of AP patients were all collected.Ranson score,acute physiology and chronic health evaluation II（APACHE II）,bedside index of severity of acute pancreatitis（BISAP）,and modified CT severity index（m CTSI）were calculated.All AP patients received appropriate treatment according to the guidelines.The patients’condition during hospitalization were followed up,and whether they were accompanied by persistent organ failure（≥48 h）were recorded.According to the new Atlanta classification of acute pancreatitis in 2012,patients with persistent organ failure were included in the SAP group.The remaining pancreatitis patients were included in the non-severe acute pancreatitis（NSAP）group.In addition,30 healthy human subjects who underwent physical examination in our hospital during the same period were selected as the control group.The peripheral blood of subjects in the control group was collected for the detection of su PAR levels,and their demographic characteristics（age and gender）were recorded.The clinical data and plasma su PAR levels of the SAP,NSAP and control group were compared.Pearson correlation was used to analyze the correlation of su PAR with Ranson,APACHE II,BISAP,m CTSI scores and common clinical inflammatory indexes.Multivariate logistic regression was used to analyze the independent predictors of SAP.The receiver operating characteristic（ROC）area under the curve（AUC）was used to evaluate the predictive value of predictors for AP severity.Nomogram was used to visualize a predictive model based on the results of a logistic regression analysis.The prediction model was evaluated by ROC curve analysis,calibration curve analysis and decision curve analysis（DCA）.Results1.A total of 103 AP patients were included,including 23 in the SAP group and 80 in the NSAP group.Besides,30 healthy people were included in the control group.There was no significant difference in age and sex composition ratio among the three groups.2.The plasma su PAR level of the SAP and NSAP groups at admission was 7.47±4.27ng/ml and 3.57±1.90 ng/ml,respectively.The control group’s plasma su PAR level at the registration time was 2.33±0.95 ng/ml.Compared with the control group,the plasma su PAR levels in the NSAP and SAP groups were significantly increased（P<0.05）,and the su PAR level in the SAP group was significantly higher than that in the NSAP group（P<0.05）.3.Pearson correlation analysis showed that su PAR level was significantly correlated with Ranson score（R=0.485,P=0.001）,APACHE II score（R=0.554,P=0.000）,BISAP score（R=0.385,P=0.001）,m CTSI score（R=0.317,P=0.001）.In addition,su PAR level was certain correlated PCT（R=0.504,P=0.000）,CRP（R=0.270,P=0.006）and IL-6（R=0.310,P=0.001）.4.Multivariate logistic regression analysis showed that su PAR,D-dimer and Ca²⁺were independent predictors of SAP.ROC curve analysis showed that plasma su PAR had an excellent predictive value for AP severity（AUC=0.869,sensitivity 87.0%,specificity72.5%）.5.The Nomogram prediction model based on su PAR,D-dimer and Ca²⁺has a higher AUC value than the AP clinical scoring system（AUC=0.972,sensitivity 95.65%,specificity 95.00%）.The calibration curve and DCA curve both performed well.Conclusion1.The plasma su PAR level of AP patients at admission increased compared with healthy people,and it was related to the severity of AP.2.Plasma su PAR levels can effectively predict the occurrence of SAP.Su PAR,D-dimer and Ca²⁺are all independent predictors of AP severity.3.The Nomogram prediction model based on su PAR,D-dimer,and Ca²⁺has a better predictive value than AP’s commonly used clinical scoring system.The prediction results of the nomogram model are in good agreement with the actual observed results.Using this predictive model to predict SAP risk can bring high clinical benefits to AP patients.Using this predictive model to predict SAP risk can bring high clinical benefits to AP patients.