Early Predictive Value Of BISAP Score Combined With Neutrophil/Lymphocyte Ratio In The Severity Of Acute Pancreatitis

Objective Acute pancreatitis(AP)is an inflammatory injury such as pancreatic edema,hemorrhage and necrosis caused by various diseases of pancreatic tissue.It involves complex pathophysiological processes.The specific pathogenesis is still not clear,and it is a common clinical emergency.One of the abdomen,the incidence rate has a tendency to increase year by year.Clinically,according to the severity of the patient's condition,it can be divided into three levels: mild,moderate and severe.Among them,mild acute pancreatitis mainly manifests as abdominal pain,nausea,vomiting,fever and other symptoms,generally does not cause organ failure,after treatment The prognosis is good.Severe acute pancreatitis is a serious condition with rapid progress,often causing multiple systemic dysfunctions such as digestion,respiration,circulation,blood,nerves,and endocrine,and even jeopardizing the life of patients,causing heavy blows and burdens on patients and their families.If the patient's condition can be reasonably and effectively predicted and evaluated at an early stage,and targeted treatment measures are taken,it is of great significance for improving the prognosis,reducing the mortality rate and reducing the economic burden.This study was designed to investigate the relations hip between the severity of acute pancreatitis and Bedside Index for Severity in Acute Pancreatitis(BISAP)score,neutrophil/lymphocyte ratio(NLR)and the predictive value of BISAP score combined with NLR in the early stage of acute pancreatitis.Methods Patients with acute pancreatitis were collected from November 2016 to October 2018 in Qingdao Municipal Hospital,Patients included in the diagnostic criteria refer to the 2012 Atlanta revised classification criteria,they were assigned to 3 groups according to the severity of the disease :the mild acute pancreatitis(MAP)group,moderately severe acute pancreatitis(MSAP)group and severe acute pancreatitis(SAP)group.Within 24 hours after admission,venous blood samples were taken for blood routine examination,liver and kidney function tests and CT examination.BISAP score and neutrophil/lymphocyte ratio were collected,searching for statistical differences in 3 groups of data.At the same time,the receiver operating characteristic(ROC)curve was drawn,and the area under the ROC curve(AUC),the best Yoden index,sensitivity,specificity,positive predictive value,negative predictive value,etc.were calculated to study the efficiency of BISAP,NLR and BISAP combined with NLR for predicting the severity of acute pancreatitis.Results A total of 165 AP patients were enrolled,including 102 in the MAP group,33 in the MSAP group,and 30 in the SAP group;105 males and 60 females;the minimum age was 21 years and the maximum age was 94 years.Etiology classification: 47 cases of biliary origin,19 cases of hyperlipidemia,14 cases of alcohol,5 cases of overeating,1 case of pregnancy,78 cases of unknown cause.There were no significant differences in gender and age between the three gr oups.BISAP score(0.57± 0.62,1.47±0.96,2.50±1.04)and NLR(4.36±3.47,8.30±2.10,11.54±6.63)of MAP group,MSAP group and SAP group increased sequentially,there was a significant difference in BISAP score and NLR between the three groups(P<0.05),and NLR was positively correlated with BISAP score(r=0.54,P<0.01).The area under the curve of BISAP score,NLR,BISAP score combined with NLR for predicting AP disease was 0.878(95% CI: 0.801~0.955,P<0.001),0.791(95% CI:0.700~0.882,P<0.001),0.911(95% CI:0.839~0.983,P<0.001)re spectively,the sensitivity was 83.3%,63.3%,83.3% respectively,the specificity was 81.5%,83.1%,95.4% respectively,the positive predictive values were 67.57%,63.33%,83.33% respectively,and the negative predictive values were 91.38%,83.08%,92.31% respectively.The differences of AUC between BISAP scores combined with NLR and single application were significant(All p<0.05).Conclusion The BISAP score and NLR of AP patients increased with the exacerbations,both of BISAP score and NLR can accurately diagnose SAP..There is a positive correlation between NLR and BISAP score,the early predictive value of AP patients can increase when they are combined.