Zhao Yi, Xia Wenwen, Lu You, Chen Wei, Zhao Yan, Zhuang Yugang
Department of Emergency, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.
Department of Gastroenterology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.
Front Surg. 2023 Jan 10;9:1026604. doi: 10.3389/fsurg.2022.1026604. eCollection 2022.
To investigate the predictive value of C-reactive protein (CRP) to serum albumin (ALB) ratio in the severity and prognosis of acute pancreatitis (AP), and compare the predictive value of the CRP/ALB ratio with the Ranson score, modified computed tomography severity index (MCTSI) score, and Bedside Index of Severity in Acute Pancreatitis (BISAP) score.
This cohort study retrospectively analyzed clinical data of AP patients from August 2018 to August 2020 in our hospital. Logistic regression analysis was utilized to determine the effects of CRP/ALB ratio, Ranson, MCTSI, and BISAP score on severe AP (SAP), pancreatic necrosis, organ failure, and death. The predictive values of CRP/ALB ratio, Ranson, MCTSI, and BISAP score were examined with the area under the curve (AUC) of the receiver operator characteristic (ROC) curve analysis. DeLong test was used to compare the AUCs between CRP/ALB ratio, Ranson, MCTSI, and BISAP score.
Totally, 284 patients were included in this study, of which 35 AP patients (12.32%) developed SAP, 29 (10.21%) organ failure, 30 (10.56%) pancreatic necrosis and 11 (3.87%) died. The result revealed that CRP/ALB ratio on day 2 was associated with SAP [odds ratio (OR): 1.74, 95% confidence interval (CI): 1.32 to 2.29], death (OR: 1.73, 95%CI: 1.24 to 2.41), pancreatic necrosis (OR: 1.28, 95%CI: 1.08 to 1.50), and organ failure (OR: 1.43, 95%CI: 1.18 to 1.73) in AP patients. Similarly, CRP/ALB on day 3 was related to a higher risk of SAP (OR: 1.50, 95%CI: 1.24 to 1.81), death (OR: 1.8, 95%CI: 1.34 to 2.65), pancreatic necrosis (OR: 1.22, 95%CI: 1.04 to 1.42), and organ failure (OR: 1.21, 95%CI: 1.04 to 1.41). The predictive value of CRP/ALB ratio for pancreatic necrosis was lower than that of MCTSI, for organ failure was lower than that of Ranson and BISAP, and for death was higher than that of MCTSI.
The CRP/ALB ratio may be a novel but promising, easily measurable, reproducible, non-invasive prognostic score that can be used to predict SAP, death, pancreatic necrosis, and organ failure in AP patients, which can be a supplement of Ranson, MCTSI, and BISAP scores.
探讨C反应蛋白（CRP）与血清白蛋白（ALB）比值对急性胰腺炎（AP）严重程度及预后的预测价值，并比较CRP/ALB比值与兰森评分、改良计算机断层扫描严重指数（MCTSI）评分及急性胰腺炎床边严重程度指数（BISAP）评分的预测价值。
本队列研究回顾性分析了2018年8月至2020年8月我院AP患者的临床资料。采用Logistic回归分析确定CRP/ALB比值、兰森评分、MCTSI评分及BISAP评分对重症急性胰腺炎（SAP）、胰腺坏死、器官衰竭及死亡的影响。采用受试者工作特征（ROC）曲线分析的曲线下面积（AUC）检验CRP/ALB比值、兰森评分、MCTSI评分及BISAP评分的预测价值。采用DeLong检验比较CRP/ALB比值、兰森评分、MCTSI评分及BISAP评分的AUC。
本研究共纳入284例患者，其中35例（12.32%）AP患者发生SAP，29例（10.21%）发生器官衰竭，30例（10.56%）发生胰腺坏死，11例（3.87%）死亡。结果显示，AP患者第2天的CRP/ALB比值与SAP[比值比（OR）：1.74，95%置信区间（CI）：1.32至2.29]、死亡（OR：1.73，95%CI：1.24至2.41）、胰腺坏死（OR：1.28，95%CI：1.08至1.50）及器官衰竭（OR：1.43，95%CI：1.18至1.73）相关。同样，第3天的CRP/ALB与SAP风险升高（OR：1.50，95%CI：1.24至1.81）、死亡（OR：1.8，95%CI：1.34至2.65）、胰腺坏死（OR：1.22，95%CI：1.04至1.42）及器官衰竭（OR：1.21，95%CI：1.04至1.41）相关。CRP/ALB比值对胰腺坏死的预测价值低于MCTSI，对器官衰竭的预测价值低于兰森评分和BISAP评分，对死亡的预测价值高于MCTSI。
CRP/ALB比值可能是一种新的、有前景的、易于测量、可重复、无创的预后评分，可用于预测AP患者的SAP、死亡、胰腺坏死及器官衰竭，可作为兰森评分、MCTSI评分及BISAP评分的补充。
