IG、NLR、MLR In Early Predicting Severity Of Acute Pancreatitis

Objective:A retrospective analysis was conducted to compare the value of Immature granulocyte（IG）,Immature granulocyte percent（IG%）,neutrophil-lymphocyte ratio（NLR）and Monocyte lymphocyte ratio（MLR）in the early prediction of acute pancreatitis.Methods:Case data of patients who were diagnosed with acute pancreatitis between July 2018 to July 2021 from the medical record system of The First Hospital of Lanzhou University were collected in the study.According to the inclusion criteria and exclusion criteria,141 cases that met the conditions were finally included.According to modified CTSI（MCTSI）score,the included patients were divided into the MAP and MSAP/SAP group.Demographic characteristics of the patients,disease etiology,past medical history,laboratory tests,medical imaging diagnostic reports and disease severity scores were recorded.Use the statistical methods to analyze the differences between the two groups.Use the Spearman correlation coefficient to determine whether there is a correlation between IG,IG%,NLR,MLR,other clinical parameters and acute pancreatitis severity scores.Univariate analysis and multivariate binary Logistic regression model were used to analyze the factors influencing the severity of acute pancreatitis,and the odds ratio（OR）and 95%confidence interval（95%CI）of the influencing factors were recorded to explore the risk factors influencing the occurrence of MSAP/SAP.The predictive value and optimal cut-off value of clinical parameters for MSAP/SAP were determined by using the receiver operating curve.The area under ROC curve（AUC）values of different clinical parameters were calculated,and the predictive value of AUC on MSAP/SAP was judged by comparing the value of AUC.The higher AUC value,the better the predictive effect of this parameter.Result:One hundred and forty-one patients with complete data who met the inclusion criteria were analyzed.Eighty-two patients were male（58.2%）and the mean age was 49.6±15.51 years,and the mean BMI was 24.06±4.04Kg/m~2.Statistical analysis of etiological data:AP was due to gallstones in 76（53.9%）,due to alcohol in6（4.3%）,due to hyperlipidemia in 37（26.2%）,and due to other causes in 22（15.6%）of the cases.The patients were divided into two groups as MAP group and MSAP/SAP group according to MCTSI score.Of these patients,70（49.6%）were in the MAP group and 71（49.6%）were in the MSAP/SAP group.General statistical data and clinical parameters between the two groups were compared,and the results were as follows:compared with MAP group,length of stay,WBC,NLR,MLR,IG,IG%,Glu andα-HBDH levels in MSAP/SAP group were significantly higher than those in MAP group（P<0.05）.While there were no significant differences in gender,age,chronic diseases（diabetes,hypertension）,BMI,HCT,PDW,RDW-SD,BUN and Crea between the two groups（P>0.05）.Spearman correlation coefficient was used to evaluate the correlation among IG,NLR,MLR and other clinical parameters,as well as severity scores of acute pancreatitis.The results showed that:（1）IG was positively correlated with BMI,WBC,NLR,MLR,Glu,α-HBDH MCTSI scores;（2）NLR was positively correlated with the length of stay in the hospital,WBC,HCT,IG,BUN,MLR,Glu,α-HBDH,MCTSI scores;（3）MLR was positively correlated with age,length of stay,WBC,HCT,IG,NLR,α-HBDH,MCTSI scores.By binary logistic regression analysis,the following conclusions were drawn:IG%（OR 7.853,95%CI1.566-39.392,P=0.012）was an independent risk factor for MSAP/SAP.Finally,the predictive ability of IG%,IG,NLR and MLR on MSAP/SAP was analyzed by ROC curve.The results showed that IG,IG%,NLR and MLR had certain value in predicting MSAP/SAP.The AUC value of IG was 0.689（95%CI 0.605-0.764,P<0.0001）,the optimal cut-off value was 0.04,and the specificity and sensitivity were94.29%and 36.62%respectively.The AUC value of IG%was 0.640（95%CI0.549-0.732,P=0.004）,the best cut-off value was 0.75,the specificity was 98.6%,and the sensitivity was 25.4%.The AUC value of NLR was 0.644（95%CI 0.552-0.736,P=0.003）,the optimal cut-off value was 5.357,the specificity was 61.43%,and the sensitivity was 70.42%.The AUC value of MLR was 0.613（95%CI 0.519-0.707,P=0.020）,the optimal cut-off value was 0.345,the specificity was 60.00%,and the sensitivity was 66.20%.Conclusion:Immature granulocyte are an independent risk factor for MSAP/SAP,that is,the higher the number of Immature granulocyte,the higher the risk of progression to MSAP/SAP in acute pancreatitis.Immature granulocyte measured in the first blood routine within 24 hours after admission are good predictors of moderate severe acute pancreatitis.Patients with AP are most likely to progress to MSAP/SAP when IG%>0.75 or IG>0.04.In this study,NLR and MLR obtained from the first blood routine after admission were not found to be independent risk factors for the occurrence of MASP/SAP.However,it has certain value in early prediction of moderate and severe acute pancreatitis.When NLR>5.357 or MLR>0.345,AP patients may progress to MSAP/SAP.