| Background and objectiveCrohn’s disease is a chronic inflammtory disease of the gastrointestinal tract,characterized by permeability impairment of the intestinal mucosal barrier.Crohn’s disease is associated with abdominal infection,such as abdominal abscess,intestinal fistula.The delayed diagnosis of Crohn’s disease complicated with intra-abdominal infection(CD-IAI)may lead to sepsis and multiple organ dysfunction syndrome.Because the symptoms of CD-IAI overlap with Crohn’s disease,CD-IAI is easily misdiagnosed as simple Crohn’s disease,leading to delayed treatment and aggravation of the disease.Therefore,there is an urgent need for economical,rapid,sensitive and specific indicators to assist in the differential diagnosis of CD-IAI and Crohn’s disease.Our research aims to explore the diagnostic value of prognostic nutritional index(PNI)and C-reative protein to albumin ratio(CAR)in CD-IAI.MethodsFrom January 2016 to December 2021,The clinical data of 61 patients with Crohn’s disease and 61 patients with CD-IAI diagnosed at Nanfang Hospital,Southern Medical University were retrospectively analyzed by 1:1 Propensity Score Matching(matching age and sex).The patients with CD-IAI included 11 cases of abdominal abscess,41 cases of intestinal fistula,and 9 cases of abdominal abscess combined with intestinal fistula.To compare the basic data of Crohn’s disease patients with CD-IAI patients,including Crohn disease activity index(CDAI),laboratory parameters,PNI and CAR.From January to May in 2022,Another 30 Crohn’s disease patients and 13 CD-IAI patients diagnosed in Nanfang Hospital,Southern Medical University were selected to verify the accuracy of PNI and CAR in predicting CD-IAI.Receiver operating characteristic curve(ROC)was used to calculate the cut-off value,area under the curve(AUC),Youden index,sensitivity and specificity of PNI and CAR for predicting CD-IAI.Spearman correlation was used to analyze the correlation between PNI,CAR and CDAI.Logistic regression was used to analyze the influencing factors of CD-IAI.Independent samples t test and Mann-Whitney U test was used for Statistical analysis.ResultsCDAI was higher in CD-IAI patients than in Crohn’s disease patients(256.68 ±8.50 vs.144.87± 7.83),and the differences was statistically significant(P<0.001).PNI was lower in CD-IAI patients than that of Crohn ’s disease patients[41.65(38.58,44.58)vs.47.80(40.45,52.98)],while CAR was higher in CD-IAI patients than in Crohn’s disease patients[1.29(0.48,2.67)vs.0.10(0.01,0.46)],all P<0.001.Spearman correlation analysis showed that PNI was negatively correlated with CAR,CDAI(r=-0.64,-0.53,all P<0.001).CAR was positively correlated with CDAI(r=0.63,all P<0.001).Logistic regression analysis showed that high level of PNI was a protective factor for CD-IAI[OR=0.91,95%confidence interval(95%CI)0.86～0.96],and high level of CAR was a risk factor for CD-IAI(OR=2.85,95%CI 1.75～4.64).ROC showed that the AUC of PNI for the diagnosis of CD-IAI was 0.701(P<0.001),the cut-off value was 45.550,Youden index was 0.426,sensitivity was 0.623,and specificity was 0.803;the AUC of CAR for the diagnosis of CD-IAI was 0.838(P<0.001),the cut-off value was 0.466,Youden index was 0.540,sensitivity was 0.770,and specificity was 0.770.The AUC of combined diagnosis of CD-IAI with PNI and CAR was 0.829(P<0.001),Youden index was 0.541,sensitivity was 0.934,and specificity was 0.607.The sensitivity and specificity of predicting CD-IAI were 0.692 and 0.967 when PNI combined with CAR reached the optimal cut-off value.ConclusionsPNI and CAR have certain diagnostic value in CD-IAI.The risk of CD-IAI is higher when PNI<45.550 and CAR>0.466. |
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