The Predictive Value Of SII In Severe Acute Pancreatitis Complicated With Multiple Organ Failure And The Efficacy Of CRRT

Objective:Severe acute pancreatitis（SAP）is a clinically common abdominal disease accompanied by organ failure lasting over 48 hours,featured with rapid progression and poor prognosis.At present,SAP complicated with persistent multiple organ failure（PMOF）is considered an independent risk factor of death.Systemic inflammatory index（SII）is a relatively new integration index,it can reflex the degree of systemic inflammation and has the value to evaluate the severity of disease.Some studies have also confirmed that SII has predictive value for severity and inflammation degree of SAP.However,there is no relevant report of SII on the predictive effect of SAP complicated with PMOF.Continuous renal replacement therapy（CRRT）is currently widely used in the treatment of SAP,but it is still controversial due to the risks of catheter infection and thrombosis,as well as the effects of reducing inflammatory mediators and inhibiting inflammation.The purpose of this study is to investigate the predictive value of SII for PMOF in SAP patients and the efficacy of CRRT for SAP,so as to provide evidence for the clinical treatment and prognosis evaluation of SAP.Methods:217 SAP patients who were admitted to The Affiliated Hospital of Qingdao University from August 1,2014 to December 31,2020 were selected in this study.Based on the improved Marshall score recommended in The Guidelines for The Diagnosis and Treatment of Acute Pancreatitis in China（2021）,patients were divided into PMOF group and non-PMOF group according to whether or not have more than 2 organs failed lasting for more than 48 hours in their clinical process.The gender,age,BMI,heart rate,mean arterial pressure and white blood cell count（WBC）,neutrophil count（NE）,lymphocyte count（Lym）,platelet count（PLT）,neutrophil lymphocyte ratio（NLR）,platelet lymphocyte ratio（PLR）,SII,procalcitonin（PCT）,C-reactive protein（CRP）,calcium ion(Ca²⁺),albumin（Alb）,triglyceride（TG）,D-dimer,lactic acid（LA）,APACHEⅡscore of patients in each group were retrospectively analyzed.T test,chi-square test,univariate analysis and multivariate logistic regression analysis were used to compare the differences between indicators in each group and determine the risk factors for PMOF in SAP patients.By drawing ROC curve,the area under the curve,optimal critical value,sensitivity and specificity were calculated to evaluate the predictive value of related factors.217 SAP patients included in this study were divided into hyperlipidemic severe acute pancreatitis group（HLSAP group）and non-hyperlipidemic acute pancreatitis group（NHLSAP group）according to the etiology,each group was divided into CRRT subgroup and conventional treatment subgroup according to different treatment methods to compare the efficacy of different treatment methods in patients with SAP.Results:1.A total of 217 patients were involved in this study,142 were male（65.44%）and75 were female（34.56%）.There were 42 cases（19.35%）in PMOF group,including 29male and 13 female,with a male to female ratio of 2.33:1.There were 175 cases（80.65%）in non-PMOF group,including 113 males and 62 females,with a male to female ratio of1.82:1.2.There were no significant differences in gender,age,BMI,heart rate,body temperature,mean arterial pressure between PMOF group and non-PMOF group（P>0.05）.SII,D-dimer,PCT,NLR and APACHEⅡscore in PMOF group were significantly higher than those in non-PMOF group（P<0.05）,serum Ca²⁺and Alb were significantly lower than those in non-PMOF group（P<0.05）.Multivariate logistic regression analysis showed that SII,APACHEⅡscore,D dimer and no CRRT performed were independent risk factors for PMOF.3.ROC curve shows that the optimal cut-off value of SII（AUC=0.714）,APACHEⅡscore（AUC=0.851）and D-dimer（AUC=0.665）for predicting PMOF in SAP patients were2707.92,15 points and 2960ng/ml respectively.4.A total of 72 patients were included in hyperlipidemic severe acute pancreatitis group（HLSAP group）,28 cases in the CRRT subgroup（H-CRRT-p group）and in the conventional treatment subgroup（H-conventional treatment-p group）each after propensity score matching,with male to female ratios of 1.55:1（17:11）and 1.39:1（18:13）respectively.A total of 145 patients were included in the non-hyperlipidemic severe acute pancreatitis group（NHLSAP group）,49 cases in the CRRT subgroup（N-CRRT-p group）and in the conventional treatment subgroup（N-conventional treatment-p group）each after propensity score matching,with male to female ratios of 1.58:1（30:19）and 1.46:1（35:24）respectively.5.After propensity score matching in NHLSAP group,general data were equally comparable between the two subgroups.After 3 days of treatment,PLR,WBC,NE,CRP,lactic acid in CRRT subgroup were reduced more effectively than those in the conventional treatment subgroup（P<0.05）.The incidence rate of sepsis and PMOF was significantly lower than that of conventional treatment subgroup（P<0.05）,serum Ca²⁺and Alb have no significant decrease compared with conventional treatment subgroup（P>0.05）.6.After propensity score matching in HLSAP group,general data were equally comparable between the two subgroups.After 3 days of treatment,SII,TG,WBC,NE,PLT,NLR,PLR,lactic acid and APACHEⅡscore in CRRT subgroup were reduced more effectively than those in the conventional treatment subgroup（P<0.05）.The incidence rate of PMOF was significantly lower than that of conventional treatment subgroup（P<0.05）,serum Ca²⁺and Alb have no significant decrease compared with conventional treatment subgroup（P>0.05）.Conclusion:1.The SII,D-Dimer,PCT,NLR and APACHEⅡscore at admission of SAP patients who developed PMOF were significantly higher than those without PMOF,serum Ca²⁺and Alb at admission were lower than those without PMOF.There were no significant differences in age,gender,BMI,heart rate,body temperature,mean arterial pressure between the two groups at admission.2.The independent risk factors for PMOF in SAP patients were SII,APACHEⅡscore,D-dimer and no CRRT performed.The predictive effect of SII,APACHEⅡscore and D-dimer on SAP complicated by PMOF were APACHEⅡscore>SII>D-dimer.When SII>2707.92,APACHEⅡscore>15,D-dimer>2960ng/ml,the likelihood of progress for PMOF should be warned.3.In SAP patients,CRRT can effectively reduce inflammatory indicators,clear triglycerides and reduce the incidence rate of complications.4.When SII>2707.92,APACHEⅡscore>15 and D-dimer>2960ng/ml,CRRT should be performed as soon as possible to improve the prognosis.