Predictive Value Of CRP、ALB、NLR In The Severity Of Acute Pancreatitis

Objective:Acute pancreatitis（AP）is a common clinical inflammatory disease with multiple etiology,complex condition and high mortality.It is one of the most refractory diseases of the digestive system.Therefore,early rapid and accurate assessment of the severity of acute pancreatitis is particularly important for guiding clinical diagnosis,making appropriate treatment plans and saving the lives of patients.The purpose of this study was to explore the predictive value of C-reactive protein（CRP）,serum albumin（ALB）and neutrophil-lymphocyte ratio（NLR）in AP severity within 24 hours after admission,and to provide a new idea for clinical diagnosis and treatment.Methods:In this study,the general and clinical data of 211 patients with acute pancreatitis（104 severe cases and 107 mild cases）admitted to the First People’s Hospital of Changde from June 2018 to June 2020 were collected retrospectively for analysis.Patients were divided into severe acute pancreatitis group（SAP）and mild acute pancreatitis group（MAP）according to their different severity,and blood routine,blood biochemical and various inflammatory factors and other related indexes were retrospectively analyzed in these two groups 24 hours after admission.The two groups were compared in gender,age,etiology,CRP,ALB,NLR,creatinine,oxygen partial pressure,fasting blood glucose and other laboratory indexes within 24 hours after admission.The correlation between the levels of CRP,ALB and NLR and the 2 score of acute physiology and chronic health（APACHEⅡ）at in 2 groups was analyzed.Receiver operating characteristic curve（ROC）was used to compare the predictive value of combined and single test for acute pancreatitis severity.Results:1.There were no significant differences in age,gender and etiology between the two groups（P>0.05）.2.The levels of CRP,NLR,APACHEⅡ,CTSI,creatinine,total bilirubin,direct bilirubin,indirect bilirubin,fasting blood glucose in SAP group were significantly higher than those in MAP group,with statistical significance （P<0.05）.The ALB、Ca²⁺and Pa O₂level in MAP group was significantly higher than that in SAP group,and the difference was statistically significant （P<0.001）.3.Alb was negatively correlated with CRP in MAP group（r=-0.254,P=0.008）.There was a negative correlation with APACHEⅡscoring system r=-0.372,P<0.001,and no significant correlation with others （P>0.05）.There was a negative correlation between ALB and CRP in SAP group,r=-0.555,P<0.001;Was negatively correlated with NLR,r=-0.319,P=0.001;Was negatively correlated with APACHEⅡscore,r=-0.569,P<0.001.CRP was positively correlated with NLR （r=0.407,P<0.001）.Was positively correlated with APACHEⅡscore,r=0.510,P<0.001;NLR was positively correlated with APACHEⅡscore （r=0.387,P<0.001）.4.When CRP was 19.75 mg/L,the maximum area under the ROC curve was 0.744,and the specificity and sensitivity were 55.1%and 88.5%,respectively.When ALB was 35.65g/L,the maximum area under the ROC curve was 0.688,and the specificity and sensitivity were 88.8%and 45.2%,respectively.When NLR was set at 9.77,the area under the ROC curve was the largest（0.703）,and the specificity and sensitivity were 55.1%and 77.9%,respectively.When the Apache Ⅱ score was 7.50,the area under the ROC curve was the largest （0.796）,and the specificity and sensitivity were 80.4%and 62.5%,respectively.When the CRP,ALB,and NLR joint prediction regression equation is 0.13,the area under the ROC curve is the largest,0.756,and the specificity and sensitivity are 84.1%and 61.5%,respectively.5.Conclusion:CRP,ALB and NLR were independent indexes to predict the severity and prognosis of acute pancreatitis.Compared with other indexes,ALB had the highest specificity,but the lowest sensitivity.Compared with other indexes,CRP and NLR have lower specificity and higher sensitivity.The area under the ROC curve was larger than that under the single index,suggesting that the combined detection of the three had a higher predictive value for the severity of acute pancreatitis.