Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India.
Department of Surgery, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India.
Wien Klin Wochenschr. 2021 Jul;133(13-14):661-668. doi: 10.1007/s00508-021-01821-2. Epub 2021 Feb 23.
An important goal in management of acute pancreatitis (AP) is early prediction and recognition of disease severity. Various predictive scoring systems are in clinical use with their own limitations and there is always a quest for simple, practical, quantifiable, dynamic and readily available markers for predicting disease severity and outcome. Complete hemogram is routinely ordered in all patients with AP. In recent years red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) and platelet lymphocyte ratio (PLR) have been found to be independent predictors of prognosis in various benign and malignant conditions. This prospective study evaluated complete hemogram based markers in AP.
Complete hemogram analysis was done and NLR, LMR, PLR values were calculated. Development of organ failure, the need for intensive care unit (ICU) admission and interventions, development of complications (local/systemic) and 100-day mortality were assessed.
In this study 160 subjects of AP were included. Complete hemogram analysis was performed within 24 h after admission. C‑reactive protein, RDW, NLR, PLR and bedside index of severity in acute pancreatitis (BISAP) values were higher in severe AP than moderate AP group than mild AP group, while LMR values were decreased in the corresponding severe, moderate and mild AP groups (p < 0.001). The NLR performed best for prediction of ICU admission, organ failure, interventions and mortality with area under receiver operating curve (AUROC) were 0.943, 0.940, 0.902 and 0.910, respectively.
Hemogram based markers are simple, objective, dynamic and readily available. They can be considered in addition to conventional multifactorial scoring systems for prediction of outcome and prognosis of AP.
急性胰腺炎（AP）管理的一个重要目标是早期预测和识别疾病的严重程度。各种预测评分系统在临床上都有应用，但都存在局限性，因此一直都在寻求简单、实用、可量化、动态和易于获取的标志物来预测疾病的严重程度和结局。所有 AP 患者都常规进行全血细胞计数。近年来，红细胞分布宽度（RDW）、中性粒细胞-淋巴细胞比值（NLR）、淋巴细胞-单核细胞比值（LMR）和血小板-淋巴细胞比值（PLR）已被发现可作为各种良性和恶性疾病预后的独立预测因子。本前瞻性研究评估了 AP 中的全血细胞计数标志物。
进行全血细胞计数分析，并计算 NLR、LMR 和 PLR 值。评估器官衰竭的发展、入住重症监护病房（ICU）的需求和干预措施、并发症（局部/全身）的发展以及 100 天死亡率。
本研究纳入了 160 例 AP 患者。在入院后 24 小时内进行全血细胞计数分析。CRP、RDW、NLR、PLR 和急性胰腺炎床边严重指数（BISAP）值在重症 AP 组中高于中度 AP 组和轻度 AP 组，而 LMR 值在相应的重症、中度和轻度 AP 组中降低（p<0.001）。NLR 对 ICU 入院、器官衰竭、干预和死亡率的预测效果最佳，其受试者工作特征曲线下面积（AUROC）分别为 0.943、0.940、0.902 和 0.910。
基于血液学的标志物简单、客观、动态且易于获取。它们可以与传统的多因素评分系统一起用于预测 AP 的结局和预后。
