TyG-BMI Index、α-HBDH In Predicting Severity Of Acute Pancreatitis

Objective:A retrospective study was performed to compare the triglyceride glucose body mass index(TyG-BMI)、ɑ-Hydroxybutyrate dehydrogenase(ɑ-HBDH)in the early predictive value of acute pancreatitis.Methods:By searching the medical record system of the First Hospital of Lanzhou University and collecting the case data of all patients initially diagnosed with acute pancreatitis during the two years from October 2020 to October 2022,194eligible patients were finally selected for inclusion in the study.The enrolled patients were divided into MAP group and MSAP/SAP group based on CTSI score.Basic data,laboratory indicators and imaging results of patients included in the study were input into EXCEL tables,and statistical software was used to analyze and compare the differences between the two groups of patients.Spearmn correlation coefficient was used to analyze the correlation between TyG-BMI index andα-hydroxybutyrate dehydrogenase and other indicators.The indicators that may affect the severity of acute pancreatitis were included in the multivariate binary Logistic regression model,and whether they were independent risk factors for the occurrence of MSAP/SAP was analyzed.The ROC curve was plotted and the area under the curve(AUC)value was calculated to compare the estimated value of these risk factors on MSAP/SAP.The larger the AUC value was,the better the predictive efficiency of the index was.Result:There were 194 eligible patients enrolled,including 105 male patients,accounting for 54%of all cases.The mean BMI was 25.86±2.03Kg/m~2.Statistical analysis of etiological data concluded that there were 56 cases of cholegenic AP,accounting for 28.9%of all patients;40 cases of hyperlipidemic AP,accounting for20.6%;98 cases of alcohol-related and other etiological AP,accounting for 50.5%.According to CTSI scoring criteria,194 patients were grouped,and the final MAP was 126 cases(64.9%),and 68 cases(35.1%)in the MSAP/SAP group.Inter-group data of the two groups were compared,and the results were as follows:The indices of Glu,NLR,HDL-C,BMI,α-HBDH,TyG index and Tyg-BMI in MSAP/SAP group were significantly higher than those in MAP group(P<0.05).Compared with MAP group,the incidence of SIRS,pleural effusion,MODS,kidney injury and other complications in MSAP/SAP group was higher,and the difference was statistically significant(P<0.05).Spearmn correlation coefficient was used to analyze TyG-BMI index,α-HBDH and other clinical indicators as well as the severity score of acute pancreatitis and to evaluate whether they were correlated.The results suggested that:(1)TyG-BMI index was positively correlated with diabetes mellitus,hyperlipidemia,leukocyte,NLR,LDL-C,creatinine,α-HBDH and CTSI score;(2)α-HBDH was positively correlated with length of hospital stay,hypertension,leukocyte,NLR,TG,Glu,urea and CTSI scores.Factors affecting AP grading criteria were included in the multivariate binary logistic regression analysis.The results were as follows:TyG-BMI index(OR 1.084,95%CI 1.026-1.146,P=0.004)andα-HBDH(OR 1.005,95%CI1.001-1.010,P=0.020)were independent risk factors for the occurrence of MSAP/SAP.ROC curve was drawn to analyze the predictive value of TyG-BMI index andα-HBDH on MSAP/SAP.The results showed that TyG-BMI index andα-HBDH had certain predictive value on the occurrence of MSAP/SAP.The AUC value of TyG-BMI index was 0.681(95%CI 0.603-0.760,P<0.001),the cut-off value was221.46,the sensitivity was 69.1%,and the specificity was 62.7%.α-HBDH predicted that the AUC value of MSAP/SAP was 0.620(95%CI 0.531-0.710,P=0.006),the cut-off value was 214.50 U/L,the sensitivity was 33.8%,and the specificity was91.3%.TyG-BMI index andα-HBDH combined indexes were analyzed and ROC curve was drawn.The results indicated that:The AUC value of the combined index of TyG-BMI andα-HBDH was 0.706(95%CI 0.627-0.784,P<0.001),the sensitivity was 66.2%,and the specificity was 69.0%.The combined index had a higher predictive value for MSAP/SAP than the single index.The included patients were divided into BAP group,HG-AP group and other etiological groups according to the etiological factors,and ROC curve was drawn.It was concluded that TyG-BMI index also had predictive value for MSAP/SAP of AP of different etiological factors.In BAP,the AUC value of TyG-BMI index predicting MSAP/SAP was 0.763(95%CI0.631-0.895,P=0.003),the cut-off value was 179.30,the sensitivity was 93.3%,and the specificity was 58.5%.In HTG-AP,the AUC value of TyG-BMI index for predicting MSAP/SAP was 0.785(95%CI 0.646-0.925,P=0.002),the cut-off value was 340.38,the sensitivity was 100%,and the specificity was 45.5%.Conclusion:The TyG-BMI index is an independent risk factor for the occurrence of MSAP/SAP,and the higher the TyG-BMI index value is,the more likely AP is to progress to MSAP/SAP.TyG-BMI index also had early predictive value for MSAP/SAP of AP caused by different etiologies(BAP and HTG-AP).The TyG-BMI index calculated according to the biochemical indexes(TG and Glu)and BMI detected within 24 hours after admission has good predictive value for the occurrence of moderate and severe acute pancreatitis.α-HBDH is also an independent risk factor for the occurrence of MSAP/SAP.The higher the value ofα-HBDH,the higher the risk of AP progressing to MSAP/SAP.TyG-BMI index combined withα-HBDH index had higher predictive value than single index in moderate and severe acute pancreatitis.