The Clinical Significance Of Inflammatory Makers In Predicting Severity Of Acute Pancreatitis

Objective:To investigate the clinical significance of inflammatory markers in predicting the severity of acute pancreatitis(AP).Methods:The study included 169 patients with AP threated in Yanbian University Hospital were selected.Acute pancreatitis was categorized into mild acute pancreatitis(MAP),moderately severe acute pancreatitis(MSAP),and severe acute pancreatitis(SAP)in accordance with the revised Atlanta classification.During the analysis,both MAP and MSAP were treated as nonSAP(n=119)group and the:neutrophil to lymphocyte ratio(NLR),nutritional index(PNI),lymphocyte to monocyte ratio(LMR),red blood cell distribution width(RDW-CV),platelet volume(MPV),platelet to lymphocyte ratio(PLR),and RDW to platelet ratio(RPR)level of peripheral blood was detected in the first,third,and seventh days after admission.The correlation between the severity of acute pancreatitis was predicted by various inflammatory markers,and the differences were statistically analyzed.Results:1.The SAP group was compared with the nonSAP group:Day1:As the illness worsened,NLR、RPR、MPV、PLR and RDW-CV gradually increased,but PNI and LMR decreased(all p<0.05).Day3 and day7:As the illness worsened,NLR、RPR、MPV and RDW-CV gradually increased,but PNI and LMR decreased(all p<0.05)2.ROC analysis:Dayl:The AUC of NLR,PNI,RDW-CV,and PLR in predicting SAP were all larger than 0.7.NLR was found to result in best AUC,which was 0.824(95%CI=0.753-0.896)and significantly higher than the AUC of PLR(Z=2.578,P<0.05).The cutoff value of NLR was 12.230,and the sensitivity and specificity were 68%and 84%,respectively.Moreover,the sum(152%)of sensitivity and specificity for NLR was largest among 7 factors and thus NLR is one of the best clinical markers to predict SAP on the first day of admission.Day3:The ROC analysis indicated that the AUC of PNI,RDW-CV,RPR,NLR and MPV were not less than 0.7.The AUC of PNI was 0.814(95%CI=0.753-0.896)which was significantly higher than that of NLR(Z=2.313,P<0.05).The cutoff value,sensitivity,and specificity were found to be 40.625,84.8%,74.1%,respectively.Additionally,the sum(158.9%)of sensitivity and specificity for PNI was largest among 7 factors and thus PNI was the most discriminative variable in predicting SAP on the third day of admission.Day7:ROC analysis revealed that the AUC of PNI and RDW-CV were 0.711 and 0.748,respectively.Although the specificity of PNI(82.9%)was relatively high,the sensitivity was low(55.8%).The specificity of RDW-CV was relatively high(86.8%)while the sensitivity was low(53.5%).Thus,RDW-CV and PNI have no clinical significances in predicting SAP.3.NLR gradually decreased and PNI decreased first then increased as the length of hospital stay was prolonged.Conclusion1.NLR,RPR,RDW-CV,MPV were associated with AP and all increased as the level of severity increased while PNI and LMR decreased.PLR was higher in SAP than nonS AP group only on the first day of admission2.NLR(dayl)and PNI(day3)were found to be more clinical significant than other inflammatory markers in predicting the severity of AP.3.NLR gradually decreased with the length of hospital stay and PNI decreased at first and then increased with the length of hospital stay.