Value of neutrophil-lymphocyte ratio combined with apolipoprotein A-I level in predicting the severity of acute pancreatitis in the early stage after admission

Jin XU; Yan PENG; Chuankang TANG

doi:10.3969/j.issn.1001-5256.2021.03.030

Volume 37 Issue 3

Mar. 2021

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2021 > 37(3): 660-665

PDF( 1991 KB)

Value of neutrophil-lymphocyte ratio combined with apolipoprotein A-I level in predicting the severity of acute pancreatitis in the early stage after admission

DOI: 10.3969/j.issn.1001-5256.2021.03.030

Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China

Received Date: 2020-10-08
Accepted Date: 2020-10-30
Published Date: 2021-03-20

Abstract

Abstract

Objective To investigate the value of neutrophil-lymphocyte ratio (NLR) combined with apolipoprotein A-I (ApoA-I) level in predicting the severity of acute pancreatitis (AP). Methods A retrospective analysis was performed for 460 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2015 to December 2019, among whom 250 had mild acute pancreatitis (MAP), 166 had moderate-severe acute pancreatitis, and 44 had severe acute pancreatitis (SAP). Related clinical data were collected, including basic information, laboratory markers (neutrophil count, lymphocyte count, serum triglyceride, serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, ApoA-I, and apolipoprotein B), and scores (Ranson, BISAP, and MCTSI). A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups; a logistic regression analysis was performed for the variables with statistical significance in univariate analysis; a Spearman correlation analysis was performed to investigate the correlation between data. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of indices, and MedCalc software was used to investigate whether there was a significant difference in diagnostic efficiency. Results There were significant differences in NLR and ApoA-I level between the groups with different severities of AP (χ²= 64.124, F=40.277, P < 0.001). On admission, NLR was positively correlated with Atlanta grading, Ranson score, MCTSI score, and BISAP score (r=0.370, 0.129, 0.260, and 0.122, all P < 0.05), and ApoA-I level was negatively correlated with Atlanta grading, Ranson score, MCTSI score, and BISAP score (r=-0.358, -0.220, -0.297, and -0.251, all P < 0.05). NLR was an independent risk factor for non-MAP (odds ratio [OR]=1.104, 95% confidence interval [CI]: 1.070-1.140, P < 0.001), while ApoA-I was an independent protective factor against non-MAP (OR=0.138, 95% CI: 0.070-0.264, P < 0.001); NLR was an independent risk factor for SAP (OR=1.163, 95% CI: 1.107-1.222, P < 0.001), while ApoA-I was an independent protective factor against SAP (OR=0.013, 95% CI: 0.003-0.056, P < 0.001). NLR had an area under the ROC curve (AUC) of 0.700 (95% CI: 0.656-0.742, P < 0.001) in predicting non-MAP; ApoA-I had an AUC of 0.684 (95% CI: 0.640-0.726, P < 0.001) in predicting non-MAP; NLR combined with ApoA-I had an AUC of 0.748 (95%CI: 0.706-0.787, P < 0.001) in predicting non-MAP. NLR combined with ApoA-I had a better value than NLR or ApoA-I alone in predicting non-MAP (Z=3.439 and 2.462, both P < 0.05). NLR had an AUC of 0.752 (95% CI: 0.710-0.791, P < 0.001) in predicting SAP; ApoA-I had an AUC of 0.797 (95% CI: 0.757-0.833, P < 0.001) in predicting SAP; NLR combined with ApoA-I had an AUC of 0.857 (95% CI: 0.822-0.888, P < 0.001) in predicting SAP. NLR combined with ApoA-I had a better value than NLR or ApoA-I alone in predicting SAP (Z=3.171 and 2.630, both P < 0.05). Conclusion NLR combined with ApoA-I can be used as a good indicator for predicting the severity of AP in the early stage after admission.
- Pancreatitis,
- Neutrophil and Lymphocyte Ratio,
- Apolipoprotein A-I,
- Severity of Illness Index

FullText(HTML)

References(26)

References

[1]	Pancreas Study Group, Chinese Society of Gastroenterology, Chinese Medical Association; Editorial Board of Chinese Journal of Pancreatology; Editorial Board of Chinese Journal of Digestion. Chinese guidelines for the management of acute pancreatitis (Shenyang, 2019)[J]. J Clin Hepatol, 2019, 35(12): 2706-2711. (in Chinese) 中华医学会消化病学分会胰腺疾病学组, 《中华胰腺病杂志》编委会, 《中华消化杂志》编委会. 中国急性胰腺炎诊治指南(2019年, 沈阳)[J]. 临床肝胆病杂志, 2019, 35(12): 2706-2711.
[2]	HE WH, ZHU Y, ZHU Y, et al. Comparison of severity and clinical outcomes between hypertriglyceridemic pancreatitis and acute pancreatitis due to other causes[J]. Natl Med J China, 2016, 96(32) : 2569-2572. (in Chinese) 何文华, 祝荫, 朱勇, 等. 高脂血症与其他病因所致急性胰腺炎的病情严重程度及预后比较[J]. 中华医学杂志, 2016, 96(32): 2569-2572.
[3]	SCHERER J, SINGH VP, PITCHUMONI CS, et al. Issues in hypertriglyceridemic pancreatitis: An update[J]. J Clin Gastroenterol, 2014, 48(3): 195-203. DOI: 10.1097/01.mcg.0000436438.60145.5a
[4]	NAWAZ H, KOUTROUMPAKIS E, EASLER J, et al. Elevated serum triglycerides are independently associated with persistent organ failure in acute pancreatitis[J]. Am J Gastroenterol, 2015, 110(10): 1497-1503. DOI: 10.1038/ajg.2015.261
[5]	DENG SY, CHANG X, YANG X, et al. Serum triglyceride levels are associated with the severity and prognosis of acute pancreatitis[J]. Acta Acad Med Mil Tert, 2017, 39(10): 97-101. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-DSDX201710018.htm 邓盛瑜, 常杏, 杨歆, 等. 血清甘油三酯水平与急性胰腺炎病情严重程度及预后相关性分析[J]. 第三军医大学学报, 2017, 39(10): 97-101. https://www.cnki.com.cn/Article/CJFDTOTAL-DSDX201710018.htm
[6]	KOLBER W, KUS'NIERZ-CABALA B, MARAJ M, et al. Neutrophil to lymphocyte ratio at the early phase of acute pancreatitis correlates with serum urokinase-type plasminogen activator receptor and interleukin 6 and predicts organ failure[J]. Folia Med Cracov, 2018, 58(4): 57-74.
[7]	ZHOU CL, ZHANG CH, ZHAO XY, et al. Early prediction of persistent organ failure by serum apolipoprotein A-I and high-density lipoprotein cholesterol in patients with acute pancreatitis[J]. Clin Chim Acta, 2018, 476: 139-145. DOI: 10.1016/j.cca.2017.11.028
[8]	BANKS PA, BOLLEN TL, DERVENIS C, et al. Classification of acute pancreatitis-2012: Revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1): 102-111. DOI: 10.1136/gutjnl-2012-302779
[9]	VALDIVIELSO P, RAMÍREZ-BUENO A, EWALD N. Current knowledge of hypertriglyceridemic pancreatitis[J]. Eur J Intern Med, 2014, 25(8): 689-694. DOI: 10.1016/j.ejim.2014.08.008
[10]	WANG XQ, SUN B, LI L, et al. Role of hyperlipidimia in pathogenesis of acute pancreatitis[J]. World Chin J Dig, 2017, 25(6): 498-503. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XXHB201706005.htm 王小倩, 孙备, 李乐, 等. 高脂血症在急性胰腺炎发病机制中的研究现状[J]. 世界华人消化杂志, 2017, 25(6): 498-503. https://www.cnki.com.cn/Article/CJFDTOTAL-XXHB201706005.htm
[11]	WU C, KE L, TONG Z, et al. Hypertriglyceridemia is a risk factor for acute kidney injury in the early phase of acute pancreatitis[J]. Pancreas, 2014, 43(8): 1312-1316. DOI: 10.1097/MPA.0000000000000180
[12]	ZHANG N, ZHANG HY, GUO XH, et al. Changes of etiology in acute pancreatitis in recent 10 years in China: Meta-analysis[J/CD]. Chin J Digest Med Imageol (Electronic Edition), 2016, 6(2): 71-75. (in Chinese) 张娜, 张海燕, 郭晓红, 等. 中国近十年急性胰腺炎病因变化特点的Meta分析[J/CD]. 中华消化病与影像杂志(电子版), 2016, 6(2): 71-75.
[13]	ZHU Y, PAN X, ZENG H, et al. A study on the etiology, severity, and mortality of 3260 patients with acute pancreatitis according to the revised atlanta classification in Jiangxi, China over an 8-year period[J]. Pancreas, 2017, 46(4): 504-509. DOI: 10.1097/MPA.0000000000000776
[14]	CHEN L, YU BP, LIN MJ. The comparison between biliary acute pancreatitis and hypertriglyceridemia induced acute pancreatitis, and the relation between triglyceride and acute pancreatitis[J]. Chin J Gastroenterol Hepatol, 2017, 26(7): 749-753. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX201707009.htm 陈雷, 余保平, 林梦娟. 胆源性急性胰腺炎与高脂血症性急性胰腺炎的比较及急性胰腺炎与甘油三酯的相关性研究[J]. 胃肠病学和肝病学杂志, 2017, 26(7): 749-753. https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX201707009.htm
[15]	HU QM, NIU CY. Predictive value of combined measurement of D-dimer, fibrinogen, and peripheral blood leukocyte count for severity of acute pancreatitis[J]. J Clin Hepatol, 2017, 33(8): 1522-1526. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2017.08.023 虎青梅, 牛春燕. D-二聚体纤维蛋白原、外周血白细胞计数联合检测对急性胰腺炎严重程度的预测价值[J]. 临床肝胆病杂志, 2017, 33(8): 1522-1526. DOI: 10.3969/j.issn.1001-5256.2017.08.023
[16]	PINHU L, QIN Y, XIONG B, et al. Overexpression of Fas and FasL is associated with infectious complications and severity of experimental severe acute pancreatitis by promoting apoptosis of lymphocytes[J]. Inflammation, 2014, 37(4): 1202-1212. DOI: 10.1007/s10753-014-9847-8
[17]	WANG H, WANG Y, TIAN QS, et al. Changes of peripheral lymphocyte subsets in rats with acute pancreatitis[J]. J Hebei Nat Sci, 2013, 35(17): 2574-2576. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ201317005.htm 王皓, 王昀, 田青山, 等. 急性胰腺炎大鼠外周淋巴细胞亚群的变化[J]. 河北医学, 2013, 35(17): 2574-2576. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ201317005.htm
[18]	HU QN, ZHANG YQ, DENG ZY, et al. Significance of prediction the severity of acute pancreatitis by neurtrophil-to-lymphocyte ration[J]. Int J Lab Med, 2013, 34(23): 3119-3121. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ201323009.htm 胡秦妮, 张玉琴, 邓芝云, 等. 中性粒细胞与淋巴细胞比值预测急性胰腺炎严重程度的意义[J]. 国际检验医学杂志, 2013, 34(23): 3119-3121. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ201323009.htm
[19]	XING ZC, WANG JH, HOU XT. Accumulation and different sources between neutrophils and monocytes in sepsis-related acute lung injury[J/CD]. Chin J Exp Clin Infect Dis (Electronic Edition, 2014, 8(3): 303-307. (in Chinese) 邢智辰, 王金宏, 侯晓彤. 中性粒细胞和单核细胞在脓毒症相关急性肺损伤聚集和来源差异的研究[J/CD]. 中华实验和临床感染病杂志(电子版), 2014, 8(3): 303-307.
[20]	VUILLEUMIER N, DAYER JM, VON ECKARDSTEIN A, et al. Pro- or anti-inflammatory role of apolipoprotein A-1 in high-density lipoproteins?[J]. Swiss Med Wkly, 2013, 143: w13781. http://europepmc.org/abstract/med/23740387
[21]	PENG YS, CHEN YC, TIAN YC, et al. Serum levels of apolipoprotein A-I and high-density lipoprotein can predict organ failure in acute pancreatitis[J]. Crit Care, 2015, 19: 88. DOI: 10.1186/s13054-015-0832-x
[22]	ZHOU CL, ZHANG CH, ZHAO XY, et al. Early prediction of persistent organ failure by serum apolipoprotein A-I and high-density lipoprotein cholesterol in patients with acute pancreatitis[J]. Clin Chim Acta, 2018, 476: 139-145. DOI: 10.1016/j.cca.2017.11.028
[23]	CASTRO FS, NASCIMENTO AM, COUTINHO IA, et al. Plasmapheresis as a therapeutic approach for hypertriglyceridemia-induced acute pancreatitis[J]. Rev Bras Ter Intensiva, 2012, 24(3): 302-307. DOI: 10.1590/S0103-507X2012000300015
[24]	BASAR R, UZUM AK, CANBAZ B, et al. Therapeutic apheresis for severe hypertriglyceridemia in pregnancy[J]. Arch Gynecol Obstet, 2013, 287(5): 839-843. DOI: 10.1007/s00404-013-2786-z
[25]	GAO F, YAN Z, ZHANG J. Association between triglyceride level and the severity of acute hypertriglyceridemic pancreatitis[J]. J Clin Hepatol, 2018, 34(11): 2360-2363. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2018.11.018 高峰, 闫真, 张杰. 甘油三酯水平与急性高脂血症性胰腺炎严重程度的关系[J]. 临床肝胆病杂志, 2018, 34(11): 2360-2363. DOI: 10.3969/j.issn.1001-5256.2018.11.018
[26]	LI HQ, LIU W, TANG J, et al. Evaluation value of triglyceride, C-reactive protein and procalcitonin on the severity and prognosis of hyperlipidemic acute pancreatitis[J]. Clin J Med Offic, 2019, 47(9): 923-925. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JYGZ201909012.htm 历海清, 刘卫, 唐郡, 等. 甘油三酯、C反应蛋白、降钙素原对高脂血症性急性胰腺炎病情严重程度及预后评估价值[J]. 临床军医杂志, 2019, 47(9): 923-925. https://www.cnki.com.cn/Article/CJFDTOTAL-JYGZ201909012.htm

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(1) / Tables(3)

Get Citation

PDF

XML

Article Metrics

Article views (433) PDF downloads(64)

Value of neutrophil-lymphocyte ratio combined with apolipoprotein A-I level in predicting the severity of acute pancreatitis in the early stage after admission

DOI: 10.3969/j.issn.1001-5256.2021.03.030

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content