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Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase

机译:急性胰腺炎早期患者的严重程度分层和预后预测

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摘要

Severity stratification and prognostic prediction at early stage is crucial for reducing the rates of mortality of patients with acute pancreatitis (AP). We aim to investigate the predicting performance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red-cell distribution width (RDW) combined with severity scores (sequential organ failure assessment [SOFA], bed-side index for severity of AP [BISAP], Ranson criteria, and acute physiology and chronic health evaluation II [APACHE II]) for severe AP (SAP) and mortality.A total of 406 patients diagnosed with AP admitted in a tertiary teaching hospital were enrolled. Demographic information and clinical parameters were retrospectively collected and analyzed. NLR, PLR, RDW, blood urea nitrogen (BUN), and AP severity scores (SOFA, BISAP, Ranson, and APACHE II) were compared between different severity groups and the survival and death group. Receiver-operating characteristic (ROC) curves for SAP and 28-day mortality were calculated for each predictor using cut-off values. Area under the curve (AUC) analysis and logistic regression models were performed to compare the performance of laboratory biomarkers and severity scores.Our results showed that NLR, PLR, RDW, glucose, and BUN level of the SAP group were significantly increased compared to the mild acute pancreatitis (MAP) group on admission (P < .001). The severity of AP increased as the NLR, SOFA, BISAP, and Ranson increased (P < .01). The AUC values of NLR, PLR, RDW, BUN, SOFA, BISAP, Ranson, and APACHE II to predict SAP were 0.722, 0.621, 0.787, 0.677, 0.806, 0.841, 0.806, and 0.752, respectively, while their AUC values to predict 28-day mortality were 0.851, 0.693, 0.885, 0.765, 0.968, 0.929, 0.812, and 0.867, respectively. BISAP achieved the highest AUC, sensitivity and NPV in predicting SAP, while SOFA is the most superior in predicting mortality. The combination of BISAP + RDW achieved the highest AUC (0.872) in predicting SAP and the combination of SOFA + RDW achieved the highest AUC (0.976) in predicting mortality. RDW (OR = 1.739), SOFA (OR = 1.554), BISAP (OR = 2.145), and Ranson (OR = 1.434) were all independent risk factors for predicting SAP, while RDW (OR = 7.361) and hematocrit (OR = 0.329) were independent risk factors for predicting mortality by logistic regression model.NLR, PLR, RDW, and BUN indicated good predictive value for SAP and mortality, while RDW had the highest discriminatory capacity. RDW is a convenient and reliable indicator for prediction not only SAP, but also mortality.
机译:早期的严重程度分层和预后预测对于降低急性胰腺炎(AP)患者的死亡率至关重要。我们旨在研究中性粒细胞-淋巴细胞比(NLR),血小板-淋巴细胞比(PLR)和红细胞分布宽度(RDW)结合严重程度评分(顺序器官衰竭评估[SOFA],床旁指数)的预测性能(APSAP的严重程度[BISAP],Ranson标准以及严重的AP(SAP)和死亡率的急性生理和慢性健康评估II [APACHE II])。共招收了三级教学医院确诊的406例AP患者。回顾性收集和分析人口统计学信息和临床参数。比较了不同严重程度组与生存和死亡组之间的NLR,PLR,RDW,血尿素氮(BUN)和AP严重程度得分(SOFA,BISAP,Ranson和APACHE II)。使用截断值为每个预测变量计算SAP的受试者工作特征(ROC)曲线和28天死亡率。进行曲线下面积(AUC)分析和逻辑回归模型以比较实验室生物标志物的性能和严重程度得分。我们的结果表明,与对照组相比,SAP组的NLR,PLR,RDW,葡萄糖和BUN水平显着增加。入院时出现轻度急性胰腺炎(MAP)组(P <.001)。 AP的严重程度随着NLR,SOFA,BISAP和Ranson的增加而增加(P <.01)。用于预测SAP的NLR,PLR,RDW,BUN,SOFA,BISAP,Ranson和APACHE II的AUC值分别为0.722、0.621、0.787、0.677、0.806、0.841、0.806和0.752,而用于预测SAP的AUC值28天死亡率分别为0.851、0.693、0.885、0.765、0.968、0.929、0.812和0.867。 BISAP在预测SAP方面获得了最高的AUC,灵敏度和NPV,而SOFA在预测死亡率方面表现最出色。 BISAP + RDW的组合在预测SAP中达到最高的AUC(0.872),而SOFA + RDW的组合在预测死亡率中达到最高的AUC(0.976)。 RDW(OR = 1.739),SOFA(OR = 1.554),BISAP(OR = 2.145)和Ranson(OR = 1.434)都是预测SAP的独立危险因素,而RDW(OR = 7.361)和血细胞比容(OR = 0.329) )是通过Logistic回归模型预测死亡率的独立危险因素.NLR,PLR,RDW和BUN对SAP和死亡率具有良好的预测价值,而RDW的判别能力最高。 RDW是一种方便可靠的指标,不仅可以预测SAP,而且可以预测死亡率。

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