Lee Sang Hoon, Lee Tae Yoon, Cheon Young Koog
Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, Korea.
Medicina (Kaunas). 2021 Dec 22;58(1):13. doi: 10.3390/medicina58010013.
Factors predictive of severe non-iatrogenic acute pancreatitis have been investigated, but few studies have evaluated prognostic markers of severe post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). The neutrophil-lymphocyte ratio (NLR) has been studied for predicting severe acute pancreatitis. We examined the predictive value of NLR in patients with PEP. From January 2012 to August 2021, 125 patients who developed PEP were retrospectively evaluated. The NLR was measured before, and on days 1 and 2 after, ERCP. PEP was categorized as mild, moderate, or severe according to consensus guidelines, based on the prolongation of planned hospitalization. Patients were divided into two groups, mild-to-moderate vs. severe PEP. We analyzed 125 patients with PEP, 18 (14.4%) of whom developed severe PEP. The baseline NLR was similar between the two groups (2.26 vs. 3.34, = 0.499). The severe PEP group had a higher NLR than the mild/moderate PEP group on days 1 (11.19 vs. 6.58, = 0.001) and 2 (15.68 vs. 5.32, < 0.001) post-ERCP. The area under the curve of the NLR on days 1 and 2 post-ERCP for severe PEP was 0.75 (95% confidence interval (CI), 0.64-0.86)) and 0.89 (95% CI, 0.81-0.97), respectively; NLR on day 2 had greater power to predict severe PEP. The optimal cutoff value of the NLR on days 1 and 2 after ERCP for prediction of severe PEP was 7.38 (sensitivity, 72%; specificity, 69%) and 8.17 (sensitivity, 83%; specificity, 83%), respectively. In a multivariate analysis, a Bedside Index of Severity in Acute Pancreatitis score ≥3 (odds ratio (OR) 9.07, = 0.012) and NLR on day 2 > 8.17 (OR 18.29, < 0.001) were significantly associated with severe PEP. The NLR on day 2 post-ERCP is a reliable prognostic marker of severe PEP.
已有研究对非医源性急性重症胰腺炎的预测因素进行了探究，但很少有研究评估内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）的预后指标。中性粒细胞与淋巴细胞比值（NLR）已被用于预测重症急性胰腺炎。我们研究了NLR对PEP患者的预测价值。2012年1月至2021年8月，对125例发生PEP的患者进行了回顾性评估。在ERCP术前、术后第1天和第2天测量NLR。根据共识指南，依据计划住院时间的延长情况，将PEP分为轻度、中度或重度。患者被分为两组，即轻度至中度PEP组与重度PEP组。我们分析了125例PEP患者，其中18例（14.4%）发生了重度PEP。两组的基线NLR相似（2.26对3.34，P = 0.499）。重度PEP组在ERCP术后第1天（11.19对6.58，P = 0.001）和第2天（15.68对5.32，P < 0.001）的NLR高于轻度/中度PEP组。ERCP术后第1天和第2天NLR对重度PEP的曲线下面积分别为0.75（95%置信区间（CI），0.64 - 0.86））和0.89（95%CI，0.81 - 0.97）；术后第2天的NLR对重度PEP的预测能力更强。ERCP术后第1天和第2天NLR预测重度PEP的最佳截断值分别为7.38（敏感性72%；特异性69%）和8.17（敏感性83%；特异性83%）。在多因素分析中，急性胰腺炎严重程度床边指数评分≥3（比值比（OR）9.07，P = 0.012）和术后第2天NLR > 8.17（OR 18.29，P < 0.001）与重度PEP显著相关。ERCP术后第2天的NLR是重度PEP的可靠预后指标。
