Association Between Neutrophil-lymphocyte Ratio (NLR) Combined With Blood Urea Nitrogen (BUN) And Acute Pancreatitis Patients' Severity And Etiology

Objective: Through the analysis of different severity of acute pancreatitis and different etiology acute pancreatitis in the levels of serum of patients with neutrophil-lymphocyte ratio(NLR)and blood urea nitrogen(BUN)level respectively,to explore the difference and significance of NLR combined with BUN in predicting the severity of acute pancreatitis and etiological classification.Methods: The clinical data of 357 patients with acute pancreatitis who were hospitalized in Shaanxi People's Hospital from January 2015 to December 2017 were retrospectively analyzed.All enrolled patients completed the related blood biochemical examination after admission.According to the Atlanta classification standard in 2012,acute pancreatitis patients are divided into three groups: mild,moderate and severe.The NLR level of three groups of patients in the morning,on the first days,third days and seventh days of admission,as well as the NLR level between groups(mild,moderate,severe)at different time points,are compared dynamically.The BUN level of three groups on the first day after hospitalization is compared.Then the levels of the NLR,BUN on the first day,and the scores of Acute physiology and chronic health evaluation(APACHE)II are analyzed respectively;by receiver operating characteristic(ROC)curve,the efficacy of NLR,BUN and APACHE II scores in the evaluation of acute pancreatitis severity for first days of admission are compared.According to the etiology of acute pancreatitis patients,acute pancreatitis patients are divided into four groups of biliary,hyperlipidemia,alcoholic,idiopathic and other causes,respectively.The levels of serum NLR and BUN in these four groups are compared,and the correlation between NLR,BUN and the different causes of acute pancreatitis were analyzed.Results:1.On the first day of admission,age,sex ratio,fasting hematocrit,alkaline phosphatase,total bilirubin,albumin,triglyceride,creatinine and blood glucose changed with the severity of disease,and the difference between the three groups is statistically significant(all P<0.05);2.In the classification of severity in the 2012 Atlanta classification,there are significant differences in serum BUN levels between the three groups of acute pancreatitis patients at the early morning of admission;the NLR values of acute pancreatitis patients at different time points(first days,third days and seventh days)are statistically significant,the NLR difference is statistically significant at each time point between the three groups(mild,moderate,severe acute pancreatitis)(all P<0.05);3.The correlation of BUN,NLR and APACHE II score for first days in hospital is analyzed respectively,the results show that on first days of hospitalization,BUN,NLR and APACHE II score is positively related(r =0.171,P =0.002;r =0.337,P<0.001);4.The ROC curve is used to analyze the value of NLR,BUN,NLR combined with BUN and APACHE II scores to predict the severity of acute pancreatitis for first days.In the prediction of moderate to severe acute pancreatitis,the Results of area under the ROC curve(AUC)of NLR combined with BUN is 0.796,second only to APACHE II score(AUC=0.886),and better than BUN(AUC=0.588)(all P<0.05),but there is no obvious advantage compared with NLR(P>0.05).In the prediction of severe acute pancreatitis,the AUC of NLR combined with BUN is 0.852,second only to the APACHE II score(AUC=0.956),and better than NLR(AUC=0.796)and BUN(AUC=0.774)alone;5.The main cause of acute pancreatitis is biliary disease.There is no statistical difference between NLR,BUN and different causes of acute pancreatitis(all P<0.05),and there is no correlation with different causes of acute pancreatitis(r=-0.096,P=0.081;r=-0.047,P=0.391);6.Multiple stepwise linear regression analysis showed that the severity of acute pancreatitis is a risk factor for the increase of NLR combined with BUN.Conclusion:1.NLR combined with BUN has a good early predictive value for assessing the severity of acute pancreatitis,and it can be used as an indicator to predict the severity of acute pancreatitis.2.The early predictive value of NLR combined with BUN for acute pancreatitis is superior to NLR and BUN alone.The higher the level of NLR combined with BUN,the heavier the severity of acute pancreatitis.3.There was no significant difference between NLR,BUN and the etiologies of acute pancreatitis.