The Value Of NLR And BUN Combined With BISAP In Early Evaluation Of The Severity Of Acute Pancreatitis

Objective:To explore the relationship between neutrophil to lymphocyte ratio(NLR),blood urea nitrogen(BUN),bedside index for severity in acute pancreatitis(BISAP)and the severity of AP,and to analyze the early predictive value of the three and the above three indexes in the early prediction of AP severity,and to compare the clinical value of the three indexes in predicting the severity of AP.Methods:The clinical data of AP patients admitted within 24 hours of onset in Jinyang Hospital affiliated to Guizhou Medical University from January 2021 to June 2022 were collected retrospectively.According to the 2012 revised Atlanta grading standard,the patients were divided into mild acute pancreatitis(MAP),moderate severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP).The general characteristics of the patients were collected,and the general characteristics and clinical data of the three groups were statistically analyzed.According to the purpose of the study,the patients were divided into non-SAP group(including MAP and MSAP)and SAP group,and the results of blood routine,blood biochemistry,chest CT and abdominal CT within 24 hours after admission were collected,and NLR,BISAP score and APACHE-II score were calculated.The relevant data were recorded in detail,and the serological examination and scoring indexes of non-SAP group and SAP group were analyzed by statistical software,and the correlation between NLR,BUN,BISAP and the severity of the disease was analyzed.The independent predictors of SAP were screened by multivariate logistic regression analysis,the receiver operating characteristic(ROC)of the subjects was drawn,and the area under curve(AUC)was calculated to further explore the predictive value of NLR,BUN and BISAP scores in the severity of AP and the application value of prognosis evaluation.Results:(1)A total of 322 patients were included,including 163 cases in MAP group(50.62%),73 cases in MSAP group(22.67%),and 86 cases in SAP group(26.71%).BMI was statistically significant among the three groups(P < 0.05).According to the purpose of the study,patients were divided into non-SAP group and SAP group,including non-SAP group 236 cases(73.29%)and SAP group 86 cases(26.71%).There was statistical significance in BMI between the two groups(P < 0.05).(2)Univariate analysis showed that: the scores of NEUT,LDH,CRP,ALT,AST,GLU,APACHE-IIand SOFA in SAP group were higher than those in non-SAP group,while LYM,PDW and CA in SAP group were lower than those in non-SAP group.There was significant difference in the scores of NLR,BUN and BISAP between the non-SAP group and the SAP group.(3)The results of multivariate logistic regression analysis showed that CA,NLR,BUN and BISAP were related to the severity of AP,and NLR,BUN and BISAP scores were independent risk factors for SAP,while CA was a protective factor for SAP.(4)For disease prediction,the AUC values of NLR,BUN and BISAP were 0.792(95%CI: 0.740-0.843,P<0.001),0.857(95%CI:0.815-0.898,P < 0.001),0.833(95%CI: 0.766-0.900,P<0.001),and the critical values were 9.998,6.05,2.50.The sensitivity and specificity were(80.2%,69.5%),(82.6%,80.1%),(72.1%,95.3%).The AUC value of NLR combined with BISAP was0.863(95%CI: 0.802-0.925 P < 0.001),the sensitivity was 82.6%,and the specificity was 88.1%.The AUC value of BUN combined with BISAP was 0.855(95%CI:0.791-0.919,P < 0.001),the sensitivity was 84.9%,and the specificity was 88.6%.The AUC value of NLR+BUN+BISAP score was 0.875(95%CI: 0.818-0.932 P <0.001),the sensitivity was 80.2%,and the specificity was 91.9%.(5)Analysis of prognosis: according to the Cut-off values of NLR,BUN and BISAP scores,the patients were divided into high value group and low value group.The hospitalization time,hospitalization time of ICU and disappearance time of abdominal pain in SAP group were longer than those in non-SAP group.APACHE-II score,CT score,mechanical ventilation rate and CRRT rate were significantly higher than those in non-SAP group.There was no significant difference in mortality between the two groups(P > 0.05).Conclusions:1.NLR,BUN,and BISAP scores are positively correlated with the severity of AP.2.NLR,BUN,and BISAP scores can be used as indicators to predict the severity of AP,and have certain predictive value for predicting the prognosis of AP patients.3.NLR,BUN,and BISAP scores are independent risk factors that affect the prognosis of AP patients.The combination of the three can predict SAP in the early stage,and the combination of the three has good clinical application value in assessing the severity and prognosis of AP.