Study On The Effect Of Acute Gastrointestinal Injury (AGI) Score Combined With MLR And NLR In Assessing The Severity Of Acute Pancreatitis

Objective:To explore the value of acute gastrointestinal injury score(AGI)combined with monocyte to lymphocyte ratio(MLR),neutrophil to lymphocyte ratio(NLR)in predicting the severity of acute pancreatitis,and provide theoretical reference for clinical early evaluation of the severity ofacute pancreatitis.Methods:Patients withacute pancreatitis admitted to the First Affiliated Hospital of Gannan Medical University from June 2019 to May 2022 were selected and met the inclusion and exclusion criteria.Collect general clinical information,biochemical indicators,clinical outcomes,and related medical history of patients,and divide them into mild pancreatitis group(MAP group,139 cases)and non mild pancreatitis group(NMAP group,57 cases)based on the severity of acute pancreatitis.Through univariate analysis,the AGI score,NLR and MLR levels and general clinical data of the two groups of patients were compared.The Spearman correlation coefficient was used to evaluate the correlation between AGI,NLR and MLR and the severity of patients’ condition and other clinical indicators.The ROC curve was used to evaluate the predictive value of AGI,NLR and MLR alone or combined diagnosis in the severity of acute pancreatitis.Results:This study ultimately included 196 patients who were divided into MAP group and NMAPgroup based on the severity of pancreatitis.Among them,139 patients(70.9%)were in the MAP group,and 57 patients(29.1%)were in the NMAP group;There was no significant difference in sex,BMI,etiology,absolute value of lymphocyte,TC,TG,HDL-C,LDL-C between the two groups(P>0.05);The age of NMAP group was lower than that of MAP group(P<0.05),but the absolute value of neutrophil,monocyte,NLR,MLR,hospital stay,AGI score,FPG and death toll in MAPgroup were higher than those in MAPgroup(P<0.05).The results of analysis by Spearman correlation coefficient showed that the AGI score was positively correlated with the absolute value of neutrophils,the absolute value of monocytes,the length of hospital stay,FPG,death,and severity,and negatively correlated with HDL-C(P<0.05);NLR was positively correlated with the absolute value of neutrophils,monocytes,hospital stay,FPG,death and severity,and negatively correlated with age and lymphocyte absolutevalue(P<0.05);MLR was positively correlated withthe absolutevalue of neutrophils,monocytes,FPG,death toll and severity,and negatively correlated with the absolute value of lymphocytes(P<0.05).Logistic regression analysis was carried out with age,sex,BMI,NLR,MLR,length of stay,AGI score and FPG as dependent variables and age,MLR,length of stay,AGI score and FPG as independent risk factors for the occurrence of NMAP in acute pancreatitis(P<0.05).The sensitivity of combined diagnosis was higher than that of NLR and MLR,but equal to AGI score;The specificity and accuracy of combined diagnosis were higher than those of NLR,MLR and AGI(P<0.05).The sensitivity and specificity of AGI score,NLR and MLR in predicting the severity of acute pancreatitis were evaluated by ROC curve.The results showed that the sensitivity and specificity of AGI were 71.9% and 69.1%respectively,the area under the ROC curve was 0.709(95% CI: 0.630～0.789,P<0.01),the sensitivity and specificity of NLR were 89.5% and 60.4%,the area under the ROC curve was0.820(95% CI: 0.756～0.883,P<0.01),and the sensitivity and specificity of MLR were 68.4%and 71.2%,respectively,The area under the ROC curve was 0.740(95% CI: 0.668 ～ 0.813,P <0.01).The sensitivity and specificity of combined diagnosis were 89.5% and 76.3%,respectively.The area under the ROC curve was 0.878(95% CI: 0.829 ～ 0.927,P<0.01).The AUC value of the combined diagnosis of the three is higher than that of AGI,NLR and MLR,andthe differenceis statisticallysignificant(P<0.05).Conclusion:1.NLR,AGIscore and MLR level in NMAPgroup werehigher thanthosein MAPgroup(P<0.05);2.NLR,MLR,hospital stay,AGI score and FPG were independent risk factors for NMAP(P<0.05);3.AGI score,NLR and MLR can be used as important indicators of the severity of acute pancreatitis.The combined diagnosis of the three has higher sensitivity and specificity,and has important clinical valuefor the earlydiagnosis of NMAP.