He Qianqian, Cui Mengwei, Li Huihui, Wang Haifeng, Li Jiye, Song Yaodong, Wang Qiaofang, Chen Sanyang, Zhu Changju
Department of Emergency Medicine, the First Affiliated Hospital of Zhengzhou University, Henan Province Emergency and Trauma Engineering Research Center, Henan Province Key Laboratory of Emergency and Trauma Research Medicine, Zhengzhou 450052, Henan, China. Corresponding author: Zhu Changju, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Nov;35(11):1207-1211. doi: 10.3760/cma.j.cn121430-20230710-00506.
To investigate the predictive value of pancreatitis activity scoring system (PASS) combined with Neutrophil to lymphocyte ratio (NLR) and C-reactive protein (CRP) for infected pancreatic necrosis (IPN) in patients with severe acute pancreatitis (SAP).
Clinical data of SAP patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to January 2023 were retrospectively collected, including basic information, vital signs at admission, first laboratory indexes within 48 hours of admission. The PASS scores at admission and 24, 48 and 72 hours after admission were calculated. According to the diagnostic criteria of IPN, the patients were divided into the non-IPN group and the IPN group, and the independent risk factors of SAP complicating IPN were determined by using univariate analysis and multifactorial Logistic regression. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of NLR, CRP, and PASS score, alone and in combination for IPN in patients with SAP.
A total of 149 SAP patients were enrolled, including 102 in the non-IPN group and 47 in the IPN group. The differences in PASS score at each time point, NLR, CRP, procalcitonin (PCT), blood urea nitrogen, blood chloride, and days of hospitalization between the two groups were statistically significant. Multifactorial Logistic regression analysis showed that 72 hours admission PASS score [odds ratio (OR) = 1.034, 95% confidence interval (95%CI) was 1.005-1.065, P = 0.022], NLR (OR = 1.284, 95%CI was 1.139-1.447, P = 0.000), and CRP (OR = 1.015, 95%CI was 1.006-1.023, P = 0.001) were independent risk factors for IPN in patients with SAP. ROC curve analysis showed that the area under the ROC curve (AUC) of the PASS score at 72 hours of admission, NLR, and CRP alone in predicting IPN in SAP patients were 0.828, 0.771, and 0.701, respectively. The AUC of NLR combined with CRP, PASS combined with NLR, and PASS combined with CRP were 0.818, 0.895, and 0.874, respectively. The combination of PASS score at 72 hours after admission, NLR, and CRP had a better predictive ability for IPN in patients with SAP (AUC = 0.922, 95%CI was 0.877-0.967), and the sensitivity was 72.3% when the cut-off value was 0.539.
The predictive value of the PASS score at 72 hours after admission, NLR and CRP in combination for IPN in SAP patients is better than that of the combination of each two and individual detection and has better test efficacy.
探讨胰腺炎活动度评分系统（PASS）联合中性粒细胞与淋巴细胞比值（NLR）及C反应蛋白（CRP）对重症急性胰腺炎（SAP）患者感染性胰腺坏死（IPN）的预测价值。
回顾性收集2020年1月至2023年1月在郑州大学第一附属医院住院的SAP患者的临床资料，包括基本信息、入院时生命体征、入院48小时内首次实验室指标。计算入院时及入院后24、48和72小时的PASS评分。根据IPN诊断标准，将患者分为非IPN组和IPN组，采用单因素分析和多因素Logistic回归确定SAP合并IPN的独立危险因素。绘制受试者工作特征曲线（ROC曲线），评估NLR、CRP及PASS评分单独及联合对SAP患者IPN的预测价值。
共纳入149例SAP患者，其中非IPN组102例，IPN组47例。两组各时间点PASS评分、NLR、CRP、降钙素原（PCT）、血尿素氮、血氯及住院天数差异有统计学意义。多因素Logistic回归分析显示，入院72小时PASS评分[比值比（OR）=1.034，95%置信区间（95%CI）为1.005 - 1.065，P = 0.022]、NLR（OR = 1.284，95%CI为1.139 - 1.447，P = 0.000）及CRP（OR = 1.015，95%CI为1.006 - 1.023，P = 0.001）是SAP患者IPN的独立危险因素。ROC曲线分析显示，入院72小时PASS评分、NLR及CRP单独预测SAP患者IPN的ROC曲线下面积（AUC）分别为0.828、0.771和0.701。NLR与CRP联合、PASS与NLR联合及PASS与CRP联合的AUC分别为0.818、0.895和0.874。入院后72小时PASS评分、NLR及CRP联合对SAP患者IPN的预测能力较好（AUC = 0.922，95%CI为0.877 - 0.967），截断值为0.539时灵敏度为72.3%。
入院后72小时PASS评分、NLR及CRP联合对SAP患者IPN的预测价值优于两两联合及单项检测，具有较好的检测效能。
