Clinical Application Of Neutrophil-lymphocyte Ratio,Red Blood Cell Distribution Width In Acute Pancreatitis

Background:Acute pancreatitis(AP)is one of the clinically common acute and critical illnesses.Its acute onset and rapid progression of the disease can easily lead to sepsis,multiple organ failure,even shock and death.Due to the large differences in individualization of clinical manifestations,it is difficult to evaluate the disease and predict the prognosis based on clinical manifestations at the early stage,and it also has a certain impact on the early adoption of reasonable treatment plans.According to the 2012 Atlanta revised standard(gold standard),AP is divided into mild acute pancreatitis,moderate-to-severe acute pancreatitis,and severe acute pancreatitis.Early assessment of the severity of the condition can help patients to be treated promptly and effectively,but Ranson score,BISAP score,APACHE-II score,etc.contain multiple laboratory test results,which cannot be obtained at the time of patient admission or within a very short period of time.Therefore,obtaining convenient,easy to operate,and affordable indicators becomes the key.Complete blood count is a routine test item for admission and is included in many AP scoring systems,such as Ranson score and APACHE-II score.Many indicators in the complete blood count are considered to be signs of inflammation,such as white blood cells,neutrophils,and neutrophil-lymphocyte ratio(NLR).AP is the process of systemic inflammation in the whole body.Both neutrophil-lymphocyte ratio(NLR)and red blood cell distribution width(RDW)can reflect systemic inflammation.In recent years,the above indicators have gradually attracted the attention of scholars and clinicians.Purpose:In this study,the clinical data of patients with acute pancreatitis were analyzed to explore the correlation between NLR and RDW and the severity of acute pancreatitis,and to explore the predictive value of NLR?RDW and their combination in acute pancreatitis,so as to provide reference value for clinical prediction of the development of mild acute pancreatitis,with a view to reducing the occurrence of acute pancreatitis complications and mortality.Method:By reviewing and collecting relevant data of patients with acute pancreatitis(AP)who were hospitalized in the Department of Gastroenterology of Shandong Provincial Hospital from December 1,2017 to March 31,2019,and met the 2012 Atlanta revised standard(gold standard),A total of 152 cases were selected,including 68 cases in mild AP(MAP)group and 84 cases in non-MAP(MSAP and SAP)group.In patients admitted to hospital within 24 hours,neutrophil-lymphocyte ratio(NLR)and red blood cell distribution width(RDW)were collected,as well as general data,experimental data and imaging data of 152 patients.Comparing MAP group with non-MAP group Differences in the above indicators between two groups to explore the relationship between NLR,RDW and MSAP and SAP,to calculate the predictive value of the two indicators for MSAP and SAP when tested separately and jointly.To explore the value of NLR,RDW and their combination for predicting the severity of acute pancreatitis,the receiver operating characteristic(ROC)curves were drawn,and the areas under the ROC curve(AUC)were calculated.The BISAP score and MCTSI score were combined with NLR+RDW to draw the ROC curve,and the AUC was calculated and compared with the AUC predicted by the two scores separately.Result:A total of 152 AP patients were included in this study,including 99 males and 53 females.According to the 2012 Atlanta revised standard,they were divided into 3 groups:MAP group(68 cases),MSAP group(67 Cases)and SAP(17 cases).Cause classification:biliary disease(75 cases),hyperlipidemia(60cases),14 cases of unknown etiology(14 cases),of alcoholic(3 cases).There were no statistical differences in gender,age and etiology classification among the three groups.According to the severity of the disease,it is divided into two groups,mild AP(MAP)group and non-MAP(MSAP and SAP)group.The median of NLR(4.21,7.69)and RDW(43.00,41.20)of the above two groups increased consecutively.It means that here were evident differences in NLR and RDW(P<0.05).The median of BISAP score(0.00,2.00)and MCTSI score(2.00,4.00)of MAP group and non-MAP group increased sequentially(P<0.05).The results of binary Logistic regression model showed that NLR,RDW,MCTSI score and BISAP score were all independent factors for prediction of the development of mild acute pancreatitis(P<0.05).NLR combined with RDW(AUC=0.750)is superior to NLR(AUC=0.735)or RDW(AUC=0.604)in predicting the severity of AP disease,(P<0.05);NLR+RDW+BISAP score(AUC=0.912)and NLR+RDW+MCTSI score(AUC=0.923)were superior to BISAP score(AUC=0.890)and MCTSI score(AUC=0.891),the above datas are evidently significant(P<0.05).Conclusion:(1)NLR and RDW reflect the severity of AP patients to a certain extent,suggesting that the expression levels of NLR and RDW can be used as independent predictors of MAP disease progression.(2)The ROC curve suggests that NLR combined with RDW has a higher early predictive value for the severity of AP patients.(3)There are positive correlations between NLR,RDW and BISAP score;NLR,RDW and MCTSI score.BISAP score or MCTSI score combined with NLR+RDW predicts higher AUC,sensitivity,and specificity than single score,indicating that any score combined with NLR+RDW has higher predictive value for the severity of AP patients.