PASS评分联合NLR和CRP对重症急性胰腺炎患者并发感染性胰腺坏死的预测价值

Predictive value of PASS score combined with NLR and CRP for infected pancreatic necrosis in patients with severe acute pancreatitis

目的探讨胰腺炎活动度评分(PASS)联合中性粒细胞与淋巴细胞比值(NLR)、C-反应蛋白(CRP)对重症急性胰腺炎(SAP)患者并发感染性胰腺坏死(IPN)的预测价值。方法回顾性收集郑州大学第一附属医院2020年1月至2023年1月收治的SAP患者的临床资料,包括基本资料、入院时生命体征、入院48 h内首次实验室指标,计算入院时及入院24、48和72 h的PASS评分。根据IPN诊断标准将患者分为非IPN组和IPN组,采用单因素分析及多因素Logistic回归分析得出SAP并发IPN的独立危险因素;绘制受试者工作特征曲线(ROC曲线)并评价NLR、CRP、PASS评分单独及联合指标对SAP并发IPN的预测价值。结果共纳入149例SAP患者,其中非IPN组102例,IPN组47例。两组间各时间点PASS评分、NLR、CRP、降钙素原(PCT)、血尿素氮、血氯、住院天数差异具有统计学意义。多因素Logistic回归分析显示,入院72 h PASS评分〔优势比(OR)=1.034,95%可信区间(95%CI)为1.005~1.065,P=0.022〕、NLR(OR=1.284,95%CI为1.139~1.447,P=0.000)、CRP(OR=1.015,95%CI为1.006~1.023,P=0.001)是SAP患者并发IPN的独立危险因素。ROC曲线分析显示,入院72 h PASS评分、NLR、CRP单独指标预测SAP患者并发IPN的ROC曲线下面积(AUC)分别为0.828、0.771、0.701;NLR联合CRP、PASS联合NLR、PASS联合CRP的AUC分别为0.818、0.895、0.874;而入院72 h PASS评分、NLR、CRP三者联合对SAP患者并发IPN具有较好的预测能力(AUC=0.922,95%CI为0.877~0.967),其截断值为0.539时,敏感度为72.3%。结论入院72 h PASS评分及NLR、CRP三者联合对SAP患者并发IPN的预测价值优于两两联合及单独检测,具有更好的检验效能。

ObjectiveTo 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).MethodsClinical 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.ResultsA 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.ConclusionsThe 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.