Hematological Indices Predicting the Severity of Acute Pancreatitis Presenting to the Emergency Department: A Retrospective Analysis.
Hematological Indices Predicting the Severity of Acute Pancreatitis Presenting to the Emergency Department: A Retrospective Analysis.
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DOI：
10.7759/cureus.16752
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发表时间：
2021-07
期刊：
影响因子：
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通讯作者：
Rajput IA
中科院分区：
文献类型：
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作者：
Khan NA;Haider Kazmi SJ;Asghar MS;Singh M;Iqbal S;Jawed R;Muhammad L;Kirmani TA;Ahmed Khan S;Rajput IA
前言急性胰腺炎是指胰腺的炎症。身体对炎症的反应是产生过量的中性粒细胞并引起淋巴细胞的程序性细胞死亡。这导致免疫不稳定，从而增加疾病的严重性和死亡率。最近的数据表明，全身炎症标志物能够预测各种疾病的预后。我们的研究目的是评估急性胰腺炎的严重程度与这些全身炎症的血液学标志物。材料与方法我们的研究是在一家三级医院的急诊科进行的，在诊断为急性胰腺炎的患者中进行。这是一项回顾性研究，通过审查医院的医疗记录来完成。血液学指标，如血红蛋白水平、红细胞压积（PCV）、红细胞（RBC）计数、平均红细胞体积（MCV）、平均红细胞血红蛋白（MCH）、平均红细胞血红蛋白浓度（MCHC）、总白细胞计数（TLC）、中性粒细胞计数、淋巴细胞计数、单核细胞计数、血小板计数、中性粒细胞与淋巴细胞计数比值（NLR）、淋巴细胞与单核细胞比值（LMR），血小板/淋巴细胞比值（PLR）与胰腺炎严重程度相关。CT严重度评分>=7分者为重症胰腺炎，低于7分者为轻中度胰腺炎。结果154例患者均进入最终分析。平均年龄48.47 ± 16.71岁。其中男性94例，女性60例。在平均血红蛋白水平、RBC计数、PCV、MCV、MCH、MCHC、淋巴细胞和血小板计数方面，研究组间无差异。TLC（p<0.001）、中性粒细胞（p<0.001）、单核细胞（p=0.008）、NLR（p<0.001）和PLR（p=0.006）在重症胰腺炎中较高，而LMR在重症胰腺炎中较低（p=0.003）。血液学指标与CT严重程度评分之间的线性关系表明，TLC（p=0.015）、中性粒细胞（p=0.005）、NLR（p=0.001）和PLR（p<0.001）与严重程度呈正相关，而淋巴细胞计数（p=0.004）和LMR（p=0.005）与重症胰腺炎呈负相关。TLC和LMR是重症胰腺炎的独立预测因子，在多变量回归分析中，校正比值比分别为12.80和5.47。结论与CT严重度评分相关的指标较多，但在受试者工作特征（ROC）分析中，仅有少数指标具有统计学意义。
Introduction Acute pancreatitis is defined as inflammation of the pancreas. The body responds to inflammation by producing excessive neutrophils and causing programmed cell death of lymphocytes. This leads to immunological instability, which increases the severity of the disease and mortality rate. Recent data suggest that markers of systemic inflammation are able to predict the prognosis of various diseases. Our study aims to assess the severity of acute pancreatitis in conjunction with these hematological markers of systemic inflammation. Materials and methods Our study was carried out in the emergency medicine department of a tertiary care hospital among patients diagnosed with acute pancreatitis. It was a retrospective study done by reviewing the hospital's medical records. Hematological indices such as hemoglobin levels, packed cell volume (PCV), red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), total leukocyte count (TLC), neutrophil count, lymphocyte count, monocyte count, platelet count, neutrophil to lymphocyte count ratio (NLR), lymphocyte to monocyte ratio (LMR), and platelet to lymphocyte ratio (PLR) were observed to be associated with severity of pancreatitis. Those with computed tomography (CT) severity score >=7 were termed as severe pancreatitis, while those below 7 were considered mild to moderate. Results A total of 154 patients were included in the final analysis. The mean age of those patients was 48.47 ± 16.71 years. There were 94 male and 60 female patients. There was no difference found among the study groups with respect to mean hemoglobin levels, RBC count, PCV, MCV, MCH, MCHC, lymphocytes, and platelet counts. TLC (p<0.001), neutrophils (p<0.001), monocytes (p=0.008), NLR (p<0.001), and PLR (p=0.006) were found higher in severe pancreatitis, while LMR was found lower in severe pancreatitis (p=0.003). A linear relationship between the hematological indices and CT severity score has shown that TLC (p=0.015), neutrophils (p=0.005), NLR (p=0.001), and PLR (p<0.001) were positively correlated with severity while lymphocyte count (p=0.004) and LMR (p=0.005) were negatively correlated with severe pancreatitis. TLC and LMR were independent predictors of severe pancreatitis with an adjusted odds ratio of 12.80 and 5.47, respectively, on multivariable regression analysis. Conclusion Many markers correlated with the CT severity score, but few of them were able to demonstrate statistical significance on receiver operating characteristic (ROC) analysis.