The Predictive Value Of Systemic Inflammatory Response Index(SIRI) In Early Stage Of Acute Pancreatitis Severity

Objective To investigate the relationship with the severity of Acute Pancreatitis(AP),this retrospective analysis was performed on all this parameters respectively: The Neutrophil to lymphocyte ratio(NLR),Platelet count to Lymphocytes ratio(PLR),Monocyte lymphocyte ratio(MLR)and SIRI.In order to evaluate its early predictive value for AP grading and provide reference for clinical diagnosis and treatment.MethodsData of patients diagnosed with acute pancreatitis in the Second Affiliated Hospital of Dalian Medical University from January 2020 to September 2022 were collected.A total of 111 patients who met the inclusion criteria and were admitted within 72 h of the onset of the disease were selected.According to the Guidelines for Diagnosis and Treatment of Acute pancreatitis in China(2021),the patients were divided into the mild(MAP)group with 84 cases,and 27 cases in moderate severe disease and severe disease(MSAP+SAP)group.The differences of age,gender,length of hospital stay and other general information between the two groups were compared.As well as relevant indicators such as blood routine and biochemistry: Lipase(LIP),amylase(AMY),monocyte count(M),alanine aminotransferase(ALT),total bilirubin(TBil)and serum creatinine(Crea)were compared.Spearman correlation analysis was used to explore the correlation between NLR,MLR,PLR,SIRI and the need for ICU treatment.Binary Logistic regression was used to analyze whether the above four indicators were independent risk factors for AP,and receiver operating characteristic curve(ROC)was drawn to compare the early predictive value of the four indicators for AP severity.Results1.According to RAC classification criteria,the patients were divided into MAP group(84 cases)and MSAP+SAP group(27 cases).There was no significant difference in the general and age data between the two groups(P>0.05),but there was significant difference in the length of hospital stay between the two groups(P<0.001).2.The statistical analysis of commonly used laboratory tests in both groups showed that there were no significant differences in lipase(LIP),amylase(AMY),monocyte count(M),alanine aminotransferase(ALT),total bilirubin(TBil)and serum creatinine(Crea)between MAP group and MSAP+SAP group(P>0.05).The levels of platelet count(P)and aspartate aminotransferase(AST)in MSAP+SAP group were significantly higher than those in MAP group,and the difference was statistically significant(P<0.05).The white blood cell count(WBC),neutrophil count(N),lymphocyte count(L)and composite index NLR,PLR,MLR and SIRI in MSAP+SAP group were significantly higher than those in MAP group,the difference was statistically significant(P<0.001).3.NLR,PLR,MLR,SIRI,BISAP score and CTSI score system were all positively correlated with ICU treatment,and the results were statistically significant(r>0,P<0.005),among which SIRI index had the highest positive correlation with ICU treatment(r=0.360,P<0.001).4.The data of WBC,AST,Platelet and SIRI were selected for Logistic regression analysis.The results showed that AST,Platelet and SIRI indexes were independent risk factors for the progression of MAP to moderate and severe pancreatitis(P<0.05).5.ROC curve results showed that the area under the NLR curve was 0.909,the optimal cut-off value was 9.68,the sensitivity was 85.2%,and the specificity was 83.3%.The area under PLR curve was 0.902,the optimal cut-off value was 195.07,the sensitivity was 85.2%,and the specificity was 84.5%.The area under the MLR curve was 0.510,the optimal cut-off value was 0.60,the sensitivity was 59.3%,and the specificity was91.7%.The area under the SIRI curve was 0.847,the optimal cut-off value was 3.64,the sensitivity was 85.2%,and the specificity was 70.2%(P<0.001),indicating that the above four indexes had good predictive value.The AUC of NLR and PLR is greater than 0.9,and the predictive value of MSAP+SAP is higher,followed by SIRI,while the predictive value of MLR is the lowest.ConclusionsCompared with the MAP group,the levels of NLR,MLR,PLR and SIRI in the MSAP+SAP group were significantly higher,indicating that they were correlated with the severity of acute pancreatitis,and had certain reference value ICU treatment,meas that it could be used as an early predictor of the severity of acute pancreatitis.Among which SIRI was a new indicator in the early severity assessment of acute pancreas,the results showed good performance,which may have certain clinical reference value.