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Yang L, He C, Wang W. Association between neutrophil to high-density lipoprotein cholesterol ratio and disease severity in patients with acute biliary pancreatitis. Ann Med 2024; 56:2315225. [PMID: 38335727 PMCID: PMC10860409 DOI: 10.1080/07853890.2024.2315225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The neutrophil to high-density lipoprotein cholesterol ratio (NHR) is independently associated with the severity of various diseases. However, its association with acute biliary pancreatitis (ABP) remains unknown. METHODS This study included 1335 eligible patients diagnosed with ABP from April 2016 to December 2022. Patients were divided into low- and high-NHR level groups using an optimal cut-off value determined utilizing Youden's index. Multivariate logistic regression analysis was used to investigate the correlation between NHR and ABP severity. Multivariate analysis-based limited restricted cubic spline (RCS) method was used to evaluate the nonlinear relationship between NHR and the risk of developing moderate or severe ABP. RESULTS In this study, multivariate logistic regression analysis indicated an independent association between NHR and ABP severity (p < .001). The RCS analysis showed a linear correlation between NHR and the risk of developing moderate or severe ABP (P for non-linearity > 0.05), and increased NHR was found to be independently associated with a more severe form of the disease. CONCLUSIONS Our study suggests that NHR is a simple and practical independent indicator of disease severity, serving as a potential novel predictor for patients with ABP.
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Affiliation(s)
- Lin Yang
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| | - Chiyi He
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| | - Wei Wang
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, China
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2
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Lee PJ, Papachristou GI, Speake C, Lacy-Hulbert A. Immune markers of severe acute pancreatitis. Curr Opin Gastroenterol 2024:00001574-990000000-00158. [PMID: 38967941 DOI: 10.1097/mog.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
PURPOSE OF THE REVIEW Acute pancreatitis is a common acute inflammatory disorder of the pancreas, and its incidence has been increasing worldwide. Approximately 10% of acute pancreatitis progresses to severe acute pancreatitis (SAP), which carries significant morbidity and mortality. Disordered immune response to pancreatic injury is regarded as a key event that mediates systemic injury in SAP. In this article, we review recent developments in immune biomarkers of SAP and future directions for research. RECENT FINDINGS Given the importance of the NLRP3-inflammasome pathway in mediating systemic inflammatory response syndrome and systemic injury, recent studies have investigated associations of SAP with systemic levels of activators of NLRP3, such as the damage associated molecular patterns (DAMPs) for the first time in human SAP. For example, circulating levels of histones, mitochondrial DNAs, and cell free DNAs have been associated with SAP. A panel of mechanistically relevant immune markers (e.g., panel of Angiopoeitin-2, hepatocyte growth factor, interleukin-8 (IL-8), resistin and sTNF-α R1) carried higher predictive accuracies than existing clinical scores and individual immune markers. Of the cytokines with established relevance to SAP pathogenesis, phase 2 trials of immunotherapies, including tumor necrosis factor (TNF)-alpha inhibition and stimulation of IL-10 production, are underway to determine if altering the immunologic response can reduce the severity of acute pancreatitis (AP). SUMMARY Circulating systemic levels of various DAMPs and a panel of immune markers that possibly reflect activities of different pathways that drive SAP appear promising as predictive biomarkers for SAP. But larger multicenter studies are needed for external validation. Studies investigating immune cellular pathways driving SAP using immunophenotyping techniques are scarce. Interdisciplinary efforts are also needed to bring some of the promising biomarkers to the bedside for validation and testing for clinical utility. Studies investigating the role of and characterization of altered gut-lymph and gut-microbiota in severe AP are needed.
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Affiliation(s)
- Peter J Lee
- Division of Gastroenterology, Hepatology, and Nutrition. Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition. Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Adam Lacy-Hulbert
- Center for Systems Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
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Xu MS, Xu JL, Gao X, Mo SJ, Xing JY, Liu JH, Tian YZ, Fu XF. Clinical study of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in hypertriglyceridemia-induced acute pancreatitis and acute biliary pancreatitis with persistent organ failure. World J Gastrointest Surg 2024; 16:1647-1659. [PMID: 38983313 PMCID: PMC11230014 DOI: 10.4240/wjgs.v16.i6.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/10/2024] [Accepted: 05/14/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel inflammatory indicators that can be used to predict the severity and prognosis of various diseases. We categorize acute pancreatitis by etiology into acute biliary pancreatitis (ABP) and hypertriglyceridemia-induced acute pancreatitis (HTGP). AIM To investigate the clinical significance of NLR and PLR in assessing persistent organ failure (POF) in HTGP and ABP. METHODS A total of 1450 patients diagnosed with acute pancreatitis (AP) for the first time at Shanxi Bethune Hospital between January 2012 and January 2023 were enrolled. The patients were categorized into two groups according to the etiology of AP: ABP in 530 patients and HTGP in 241 patients. We collected and compared the clinical data of the patients, including NLR, PLR, and AP prognostic scoring systems, within 48 h of hospital admission. RESULTS The NLR (9.1 vs 6.9, P < 0.001) and PLR (203.1 vs 160.5, P < 0.001) were significantly higher in the ABP group than in the HTGP group. In the HTGP group, both NLR and PLR were significantly increased in patients with severe AP and those with a SOFA score ≥ 3. Likewise, in the ABP group, NLR and PLR were significantly elevated in patients with severe AP, modified computed tomography severity index score ≥ 4, Japanese Severity Score ≥ 3, and modified Marshall score ≥ 2. Moreover, NLR and PLR showed predictive value for the development of POF in both the ABP and HTGP groups. CONCLUSION NLR and PLR vary between ABP and HTGP, are strongly associated with AP prognostic scoring systems, and have predictive potential for the occurrence of POF in both ABP and HTGP.
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Affiliation(s)
- Mu-Sen Xu
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Jia-Le Xu
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Xin Gao
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Shao-Jian Mo
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Jia-Yu Xing
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Jia-Hang Liu
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Yan-Zhang Tian
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Xi-Feng Fu
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
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Huang Q, Liu JW, Dong HB, Wei ZJ, Liu JZ, Ren YT, Jiang X, Jiang B. Mesenteric adipose tissue B lymphocytes promote intestinal injury in severe acute pancreatitis by mediating enteric pyroptosis. Hepatobiliary Pancreat Dis Int 2024; 23:300-309. [PMID: 38057185 DOI: 10.1016/j.hbpd.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Visceral adipose tissue (VAT) has been linked to the severe acute pancreatitis (SAP) prognosis, although the underlying mechanism remains unclear. It has been reported that pyroptosis worsens SAP. The present study aimed to verify whether mesenteric adipose tissue (MAT, a component of VAT) can cause secondary intestinal injury through the pyroptotic pathway. METHODS Thirty-six male Sprague Dawley (SD) rats were divided into six different groups. Twelve rats were randomly divided into the SAP and control groups. We monitored the changes of MAT and B lymphocytes infiltration in MAT of SAP rats. Twelve SAP rats were injected with MAT B lymphocytes or phosphate buffer solution (PBS). The remaining twelve SAP rats were first injected with MAT B lymphocytes, and then with MCC950 (NLRP3 inhibitor) or PBS. We collected blood and tissue samples from pancreas, gut and MAT for analysis. RESULTS Compared to the control rats, the SAP group showed inflammation in MAT, including higher expression of tumor necrosis factor (TNF-α) and interleukin-6 (IL-6), lower expression of IL-10, and histological changes. Flow cytometry analysis revealed B lymphocytes infiltration in MAT but not T lymphocytes and macrophages. The SAP rats also exhibited intestinal injury, characterized by lower expression of zonula occludens-1 (ZO-1) and occludin, higher levels of lipopolysaccharide and diamine oxidase, and pathological changes. The expression of NLRP3 and n-GSDMD, which are responsible for pyroptosis, was increased in the intestine of SAP rats. The injection of MAT B lymphocytes into SAP rats exacerbated the inflammation in MAT. The upregulation of pyroptosis reduced tight junction in the intestine, which contributed to the SAP progression, including higher inflammatory indicators and worse histological changes. The administration of MCC950 to SAP + MAT B rats downregulated pyroptosis, which subsequently improved the intestinal barrier and ameliorated inflammatory response of SAP. CONCLUSIONS In SAP, MAT B lymphocytes aggravated local inflammation, and promoted the injury to the intestine through the enteric pyroptotic pathway.
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Affiliation(s)
- Qing Huang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Jia-Wen Liu
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Hai-Bin Dong
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Zheng-Jie Wei
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Jin-Zhe Liu
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Yu-Tang Ren
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Xuan Jiang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China.
| | - Bo Jiang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
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Delgado-Miguel C, Miguel-Ferrero M, García A, Delgado B, Camps J, Martínez L. Neutrophil-to-lymphocyte ratio as a predictor of postoperative complications and readmissions after appendectomy in children. Updates Surg 2023; 75:2273-2278. [PMID: 37659982 DOI: 10.1007/s13304-023-01639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
To analyze the role of neutrophil-to-lymphocyte ratio (NLR) in predicting the development of postoperative complications and readmission after appendectomy in children. A retrospective single-centered case-control study was conducted on children who underwent appendectomy between 2017 and 2020. Demographics, time since symptoms onset, laboratory tests at admission, postoperative complications, and readmissions in the first 30 days after surgery were recorded. Sensitivity and specificity analysis of the parameters evaluated were determined by the area under the curve (AUC) represented on the receiver operating characteristic (ROC) curves. A total of 1,214 patients (765 males; 449 females) were included, with a median age at diagnosis of 10.4 years. The median time from symptom onset was 24 h. During the first 30 days after surgery, 149 postoperative complications were reported (12.3%). NLR at admission presented the highest AUC (0.753), with a cut-off point of 10.5 for maximum sensitivity (68.7%) and specificity (86.1%). Readmissions were reported in 45 cases (3.7%). NLR at admission presented an AUC of 0.794 significantly higher than neutrophils (0.696), leukocytes (0.654), and time since symptom onset (0.622), making these differences statistically significant (p < 0.001). The cut-off point of NLR > 12.4 was estimated, with a maximum sensitivity and specificity of 71.0% and 82.3% for predicting readmission. NLR is an independent predictor of postoperative complications and readmission in children with acute appendicitis. While its application in routine clinical practice has yet to be established, the NLR may provide clinicians with a tool for identifying high-risk surgical patients.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, Prisma Health Children's Hospital, 9 Richland Medical Park, Columbia, SC, 29203, USA.
- Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain.
| | | | - Antonella García
- Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
| | - Bonifacio Delgado
- Department of Pediatric Surgery, Prisma Health Children's Hospital, 9 Richland Medical Park, Columbia, SC, 29203, USA
| | - Juan Camps
- Department of Pediatric Surgery, Prisma Health Children's Hospital, 9 Richland Medical Park, Columbia, SC, 29203, USA
| | - Leopoldo Martínez
- Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
- Institute for Biomedical Research La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
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NLR, MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the intensive care unit. Sci Rep 2022; 12:15974. [PMID: 36153405 PMCID: PMC9509334 DOI: 10.1038/s41598-022-20385-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width (RDW) are emerging biomarkers to predict outcomes in general ward patients. However, their role in the prognostication of critically ill patients with pneumonia is unclear. A total of 216 adult patients were enrolled over 2 years. They were classified into viral and bacterial pneumonia groups, as represented by influenza A virus and Streptococcus pneumoniae, respectively. Demographics, outcomes, and laboratory parameters were analysed. The prognostic power of blood parameters was determined by the respective area under the receiver operating characteristic curve (AUROC). Performance was compared using the APACHE IV score. Discriminant ability in differentiating viral and bacterial aetiologies was examined. Viral and bacterial pneumonia were identified in 111 and 105 patients, respectively. In predicting hospital mortality, the APACHE IV score was the best prognostic score compared with all blood parameters studied (AUC 0.769, 95% CI 0.705–0.833). In classification tree analysis, the most significant predictor of hospital mortality was the APACHE IV score (adjusted P = 0.000, χ2 = 35.591). Mechanical ventilation was associated with higher hospital mortality in patients with low APACHE IV scores ≤ 70 (adjusted P = 0.014, χ2 = 5.999). In patients with high APACHE IV scores > 90, age > 78 (adjusted P = 0.007, χ2 = 11.221) and thrombocytopaenia (platelet count ≤ 128, adjusted P = 0.004, χ2 = 12.316) were predictive of higher hospital mortality. The APACHE IV score is superior to all blood parameters studied in predicting hospital mortality. The single inflammatory marker with comparable prognostic performance to the APACHE IV score is platelet count at 48 h. However, there is no ideal biomarker for differentiating between viral and bacterial pneumonia.
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Schlanger D, Popa C, Pașca S, Seicean A, Al Hajjar N. The role of systemic immuno-inflammatory factors in resectable pancreatic adenocarcinoma: a cohort retrospective study. World J Surg Oncol 2022; 20:144. [PMID: 35513845 PMCID: PMC9074307 DOI: 10.1186/s12957-022-02606-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pancreatic cancer is an aggressive malignancy, surgery being the only potentially curative treatment. The systemic inflammatory response is an important factor in the development of cancer. There is still controversy regarding its role in pancreatic cancer. METHODS Our study is a retrospective observational cohort study. We included patients diagnosed with pancreatic ductal adenocarcinoma (PDAC), who underwent surgical resection in our hospital, between January 2012 and December 2019. We gathered information from preoperative and postoperative blood tests. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) were determined. RESULTS We included 312 patients. All the immune-inflammatory scores assessed significantly changed after the surgery. The impact on overall survival of these markers showed that only some of the postoperative scores predicted survival: high PLR had a negative prognostic impact, while high lymphocyte and PNI values had a positive effect on overall survival. DISCUSSION The circulating immune cells and their values integrated in the assessed prognostic scores suffer statistically significant changes after curative pancreatic surgery. Only the postoperative values of lymphocyte count, PLR, and PNI seem to influence the overall survival in PDAC. TRIAL REGISTRATION ClinicalTrials.gov-identifier NCT05025371 .
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Affiliation(s)
- D. Schlanger
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
| | - C. Popa
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
| | - S. Pașca
- Department of Haematology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400012 Cluj-Napoca, Romania
| | - A. Seicean
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Gastroenterology Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162 Cluj-Napoca, Romania
| | - N. Al Hajjar
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
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Yang Y, Xiao W, Liu X, Zhang Y, Jin X, Li X. Machine Learning-Assisted Ensemble Analysis for the Prediction of Acute Pancreatitis with Acute Kidney Injury. Int J Gen Med 2022; 15:5061-5072. [PMID: 35607360 PMCID: PMC9123915 DOI: 10.2147/ijgm.s361330] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Acute kidney injury (AKI) is a frequent complication of severe acute pancreatitis (AP) and carries a very poor prognosis. The present study aimed to construct a model capable of accurately identifying those patients at high risk of harboring occult acute kidney injury (AKI) characteristics. Patients and Methods We retrospectively recruited a total of 424 consecutive patients at the Gezhouba central hospital of Sinopharm and Xianning central hospital between January 1, 2016, and October 30, 2021. ML-assisted models were developed from candidate clinical features using two-step estimation methods. The receiver operating characteristic curve (ROC), decision curve analysis (DCA), and clinical impact curve (CIC) were performed to evaluate the robustness and clinical practicability of each model. Results Finally, a total of 30 candidate variables were included, and the AKI prediction model was established by an ML-based algorithm. The areas under the ROC curve (AUCs) of the random forest classifier (RFC) model, support vector machine (SVM), eXtreme gradient boosting (XGBoost), artificial neural network (ANN), and decision tree (DT) ranged from 0.725 (95% CI 0.223–1.227) to 0.902 (95% CI 0.400–1.403). Among them, RFC obtained the optimal prediction efficiency via adding inflammatory factors, which are serum creatinine (Scr), C-reactive protein (CRP), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-albumin ratio (NAR), and CysC, respectively. Conclusion We successfully developed ML-based prediction models for AKI, particularly the RFC, which can improve the prediction of AKI in patients with AP. The practicality of prediction and early detection may be greatly beneficial to risk stratification and management decisions.
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Affiliation(s)
- Yi Yang
- Department of Clinical Laboratory, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, People’s Republic of China
| | - Wei Xiao
- Department of Gastroenterology, Xianning central Hospital, The First Affiliated Hospital of Hubby University of Science and Technology, Xianning, People’s Republic of China
| | - Xingtai Liu
- Department of Clinical Laboratory, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, People’s Republic of China
| | - Yan Zhang
- Department of Clinical Laboratory, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, People’s Republic of China
| | - Xin Jin
- Department of Clinical Laboratory, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, People’s Republic of China
| | - Xiao Li
- Department of Clinical Laboratory, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, People’s Republic of China
- Correspondence: Xiao Li, Department of Clinical Laboratory, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, 443002, People’s Republic of China, Tel +86 717-672020, Email
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9
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Liu X, Guan G, Cui X, Liu Y, Liu Y, Luo F. Systemic Immune-Inflammation Index (SII) Can Be an Early Indicator for Predicting the Severity of Acute Pancreatitis: A Retrospective Study. Int J Gen Med 2021; 14:9483-9489. [PMID: 34949937 PMCID: PMC8689009 DOI: 10.2147/ijgm.s343110] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Systemic immune-inflammation index (SII) is a new systemic inflammatory prognostic indicator associated with outcomes in patients with different tumors. Studies have shown an association between SII and many chronic/acute inflammatory diseases. This study aimed at exploring whether SII can be used as an effective parameter for predicting the severity of acute pancreatitis (AP). Methods A total of 101 acute pancreatitis patients were enrolled in this study (mild acute pancreatitis (MAP): n = 73 and severe acute pancreatitis (SAP): n = 28). Patient demographics and SII were analyzed using the chi-square test, Student’s t-test, and Mann–Whitney U-test. A receiver operating characteristic curve was generated to test the potential of using neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and SII to predict AP’s severity. Logistic regression analysis was performed to determine major risk factors. Results Patients with SII value ≥2207.53 had a higher probability of having SAP (sensitivity = 92.9%, specificity = 87.7%, and AUC = 0.920), and SII was a significantly better predictive value than PLR and NLR. Logistic regression analysis results showed SII could differentiate MAP from SAP as a major risk factor. Conclusion This study has shown that SII is a potential indicator for predicting the severity of acute pancreatitis. The findings suggested that SII is more sensitive and specific than NLR and PLR in predicting the severity of acute pancreatitis.
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Affiliation(s)
- Xingming Liu
- Department of General Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, 116023, People's Republic of China
| | - Guoxin Guan
- Department of General Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, 116023, People's Republic of China
| | - Xinye Cui
- Department of General Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, 116023, People's Republic of China
| | - Yaqing Liu
- Department of General Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, 116023, People's Republic of China
| | - Yinghan Liu
- Department of General Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, 116023, People's Republic of China
| | - Fuwen Luo
- Department of General Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, 116023, People's Republic of China
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Alpua M, Say B, Yardimci I, Ergün U, Kisa U, Ceylan OD. Response to Letter to the Editor: "First Admission Neutrophil-Lymphocyte Ratio May Indicate Acute Prognosis of Ischemic Stroke". Rambam Maimonides Med J 2021; 12:RMMJ.10457. [PMID: 34709173 PMCID: PMC8549841 DOI: 10.5041/rmmj.10457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We have carefully read and evaluated the letter writ¬ten by Drs Mungmunpuntipantip and Wiwanitkit regarding our article published in the July issue of Rambam Maimonides Medical Journal.
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Affiliation(s)
- Murat Alpua
- Department of Neurology, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Bahar Say
- Department of Neurology, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Ilknur Yardimci
- Department of Neurology, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Ufuk Ergün
- Department of Neurology, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Ucler Kisa
- Department of Biochemistry, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Ozlem Doğan Ceylan
- Department of Medical Biochemistry, Ankara University, Faculty of Medicine, Ankara, Turkey
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11
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Tahir H, Rahman S, Habib Z, Khan Y, Shehzad S. Comparison of the Accuracy of Modified CT Severity Index Score and Neutrophil-to-Lymphocyte Ratio in Assessing the Severity of Acute Pancreatitis. Cureus 2021; 13:e17020. [PMID: 34522501 PMCID: PMC8425492 DOI: 10.7759/cureus.17020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 12/13/2022] Open
Abstract
Background Acute pancreatitis is an acute gastrointestinal emergency with significant morbidity and mortality if not treated. It can lead to local as well as systemic complications and has a prevalence of 51.07%. Laboratory investigations such as amylase and lipase and ultrasound scan are typically used for the diagnosis. A contrast-enhanced CT scan is considered the gold standard. Both laboratory and radiological investigation-based scoring systems have been reported in the literature and are in practice. However, these modalities demand several laboratory investigations and are expensive. Our study aims to determine the congruency of the neutrophil-to-lymphocyte ratio (NLR) and the modified CT severity index score (MCTSI) with the revised Atlanta classification in assessing the severity of acute pancreatitis. In addition, the accuracy of NLR and MCTSI is determined. The secondary objective is to determine whether NLR can predict the severity of acute pancreatitis to the same extent as MCTSI through expensive radiological imaging and other clinical scoring systems through a list of investigations. Methodology The data for this study were collected retrospectively and patients with a diagnosis of acute pancreatitis were included through the nonprobability convenience sampling method. All patients underwent relevant laboratory workup (including complete blood count) and radiological workup (including CT scan) during their hospital stay. The main outcome measures were sensitivity, specificity, and accuracy of NLR and MCTSI, and the congruency of these with the revised Atlanta classification in assessing the severity of acute pancreatitis. Results A total of 166 patients with acute pancreatitis were included, of which 107 (64.45%) were males and 59 (35.55%) were females, with a mean age of 43.7. The sensitivity, specificity, and accuracy of NLR were 67%, 90.9%, and 76%, respectively, whereas the sensitivity, specificity, and accuracy of MCTSI were 95%, 13.6%, and 62%, respectively. The area under the curve for NLR was 0.855 whereas that for MCTSI was determined to be 0.645. Conclusions NLR has a good concordance with the revised Atlanta classification and assesses the disease severity, especially in moderate-to-severe cases of acute pancreatitis compared to MCTSI. In addition, NLR can be used in acute and/or resource-poor settings to predict the severity of acute pancreatitis.
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Affiliation(s)
- Hasan Tahir
- Department of Plastic and Reconstructive Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Sheeraz Rahman
- Department of General Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Zahid Habib
- Department of General Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Yusra Khan
- General Surgery, Karachi Medical and Dental College, Karachi, PAK
| | - Saleha Shehzad
- Department of Radiology, Liaquat National Hospital and Medical College, Karachi, PAK
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Gezer NS, Bengi G, Baran A, Erkmen PE, Topalak ÖS, Altay C, Dicle O. Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis. ACTA ACUST UNITED AC 2020; 66:762-770. [PMID: 32696885 DOI: 10.1590/1806-9282.66.6.762] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/24/2019] [Indexed: 12/12/2022]
Abstract
Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis BACKGROUND/AIMS To compare radiological scoring systems, clinical scores, serum C-reactive protein (CRP) levels and the neutrophil-lymphocyte ratio (NLR) for predicting the severity and mortality of acute pancreatitis (AP). MATERIALS AND METHODS Demographic, clinical, and radiographic data from 80 patients with AP were retrospectively evaluated. The harmless acute pancreatitis score (HAPS), systemic inflammatory response syndrome (SIRS), bedside index for severity in acute pancreatitis (BISAP), Ranson score, Balthazar score, modified computed tomography severity index (CTSI), extrapancreatic inflammation on computed tomography (EPIC) score and renal rim grade were recorded. The prognostic performance of radiological and clinical scoring systems, NLR at admission, and serum CRP levels at 48 hours were compared for severity and mortality according to the revised Atlanta Criteria. The data were evaluated by calculating the receiver operator characteristic (ROC) curves and area under the ROC (AUROC). RESULTS Out of 80 patients, 19 (23.8%) had severe AP, and 9 (11.3%) died. The AUROC for the BISAP score was 0.836 (95%CI: 0.735-0.937), with the highest value for severity. With a cut-off of BISAP ≥2, sensitivity and specificity were 68.4% and 78.7%, respectively. The AUROC for NLR was 0.915 (95%CI: 0.790-1), with the highest value for mortality. With a cut-off of NLR >11.91, sensitivity and specificity were 76.5% and 94.1%, respectively. Of all the radiological scoring systems, the EPIC score had the highest AUROC, i.e., 0.773 (95%CI: 0.645-0.900) for severity and 0.851 (95%CI: 0.718-0.983) for mortality, with a cut-off value ≥6. CONCLUSION The BISAP score and NLR might be preferred as early determinants of severity and mortality in AP. The EPIC score might be suggested from the current radiological scoring systems.
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Affiliation(s)
- Naciye S Gezer
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Göksel Bengi
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Agah Baran
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Pakize E Erkmen
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ömer S Topalak
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Canan Altay
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Oğuz Dicle
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Mubder M, Dhindsa B, Nguyen D, Saghir S, Cross C, Makar R, Ohning G. Utility of inflammatory markers to predict adverse outcome in acute pancreatitis: A retrospective study in a single academic center. Saudi J Gastroenterol 2020; 26:290343. [PMID: 32719240 PMCID: PMC7580735 DOI: 10.4103/sjg.sjg_49_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND/AIM Acute pancreatitis (AP) is a commonly encountered emergency where early identification of complicated cases is important. Inflammatory markers like lymphocyte to monocyte ratio (LMR) and neutrophil to lymphocyte ratio (NLR) are simple and readily available markers. In this study, we evaluated the utility of these markers in the early identification of patients with complicated AP. PATIENTS AND METHODS All patients with a diagnosis of AP admitted to the University Medical Center in Las Vegas/Nevada between August 2015 and September 2018 were identified using ICD-10 codes. Medical records were reviewed retrospectively. Epidemiological measures and their associated confidence intervals were calculated using MedCalc (v. 18). RESULTS The LMR showed a significant difference between groups, with the non-complicated cases consistently higher than the complicated cases but without significant temporal differences. The NLR showed a significant difference with a significant temporal relation. Using the bound of the 95% confidence interval separating the two groups, LMR <2 was found to be associated with a complicated case and NLR >10.5 was suggestive of a complicated case. High specificity (85-92%) with low sensitivity (23-69%) was noted; hence, these cut points were very good at discerning non-complicated cases. CONCLUSION Our data show persistently low LMR that is associated with severe AP and a value of <2.0 can be used clinically to predict severe AP on admission. It also shows that elevated NLR is associated with complicated AP and prolonged hospital stay with a value >10.5 that can be used to predict severe complicated AP and to monitor response to treatment over time.
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Affiliation(s)
- Mohamad Mubder
- Department of Internal Medicine, School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV, United States
| | - Banreet Dhindsa
- Department of Internal Medicine, School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV, United States
| | - Danny Nguyen
- Department of Internal Medicine, School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV, United States
| | - Syed Saghir
- Department of Internal Medicine, School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV, United States
| | - Chad Cross
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV, United States
| | - Ranjit Makar
- Department of Gastroenterology and Hepatology, School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV, United States
| | - Gordon Ohning
- Department of Gastroenterology and Hepatology, School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV, United States
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Yoon JB, Lee SH. The neutrophil-to-lymphocyte ratio has feasible predictive value for hospital mortality in patients with small bowel obstruction in the emergency department. Am J Emerg Med 2020; 44:428-433. [DOI: 10.1016/j.ajem.2020.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 12/29/2022] Open
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Diagnostic Value of Neutrophil-Lymphocyte Ratio for Predicting the Severity of Acute Pancreatitis: A Meta-Analysis. DISEASE MARKERS 2020; 2020:9731854. [PMID: 32454909 PMCID: PMC7232731 DOI: 10.1155/2020/9731854] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/14/2020] [Accepted: 03/28/2020] [Indexed: 12/18/2022]
Abstract
Background Acute pancreatitis (AP) is a life-threatening disease caused by a variety of factors, and once it progresses to severe acute pancreatitis, the prognosis is poor. The purpose of this study was to investigate the diagnostic value of the neutrophil-lymphocyte ratio (NLR) for predicting the severity of acute pancreatitis. Materials and Methods We searched the databases of PubMed, EMBASE, Web of Science, and Cochrane Library to identify eligible studies using the NLR to predict the severity of AP. The sensitivity (SEN), specificity (SPE), negative likelihood ratio (NLR), positive likelihood ratio (PLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) were combined using a bivariate mixed model. Results A total of 10 articles containing 394 cases and 1319 controls were included in the study. The combined SEN, SPE, NLR, PLR, DOR, and AUC are 79% (73%-84%), 71% (59%-80%), 0.30 (0.21-0.41), 2.7 (1.8-4.0), 9 (5-18), and 0.82 (0.78-0.85), respectively. Conclusions NLR has a moderately high diagnostic value in predicting the severity of acute pancreatitis.
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Márta K, Lazarescu AM, Farkas N, Mátrai P, Cazacu I, Ottóffy M, Habon T, Erőss B, Vincze À, Veres G, Czakó L, Sarlós P, Rakonczay Z, Hegyi P. Aging and Comorbidities in Acute Pancreatitis I: A Meta-Analysis and Systematic Review Based on 194,702 Patients. Front Physiol 2019; 10:328. [PMID: 31001131 PMCID: PMC6454469 DOI: 10.3389/fphys.2019.00328] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Acute pancreatitis (AP) is one of the most common cause of hospitalization among gastrointestinal diseases worldwide. Although most of the cases are mild, approximately 10-20% of patients develop a severe course of disease with higher mortality rate. Scoring systems consider age as a risk factor of mortality and severity (BISAP; >60 years, JPN>70 years, RANSON; >55 years, APACHE II >45 years). If there is a correlation between aging and the clinical features of AP, how does age influence mortality and severity? Aim: This study aimed to systematically review the effects of aging on AP. Methods: A comprehensive systematic literature search was conducted in the Embase, Cochrane, and Pubmed databases. A meta-analysis was performed using the preferred reporting items for systematic review and meta-analysis statement (PRISMA). A total of 1,100 articles were found. After removing duplicates and articles containing insufficient or irrelevant data, 33 publications involving 194,702 AP patients were analyzed. Seven age categories were determined and several mathematical models, including conventional mathematical methods (linear regression), meta-analyses (random effect model and heterogeneity tests), meta-regression, funnel plot and Egger's test for publication bias were performed. Quality assessment was conducted using the modified Newcastle-Ottawa scale. The meta-analysis was registered in the PROSPERO database (CRD42017079253). Results: Aging greatly influences the outcome of AP. There was a low severe AP incidence in patients under 30 (1.6%); however, the incidence of severe AP showed a continuous, linear increase between 20 and 70 (0.193%/year) of up to 9.6%. The mortality rate was 0.9% in patients under 20 and demonstrated a continuous linear elevation until 59, however from this age the mortality rate started elevating with 9 times higher rate until the age of 70. The mortality rate between 20 and 59 grew 0.086%/year and 0.765%/year between 59 and 70. Overall, patients above 70 had a 19 times higher mortality rate than patients under 20. The mortality rate rising with age was confirmed by meta-regression (coefficient: 0.037 CI: 0.006-0.068, p = 0.022; adjusted r2: 13.8%), and severity also (coefficient: 0.035 CI: 0.019-0.052, p < 0.001; adjusted r2: 31.6%). Conclusion: Our analysis shows a likelihood of severe pancreatitis, as well as, pancreatitis-associated mortality is more common with advanced age. Importantly, the rapid elevation of mortality above the age of 59 suggests the involvement of additional deteriorating factors such as co-morbidity in elderly.
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Affiliation(s)
- Katalin Márta
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Alina-Marilena Lazarescu
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- County Emergency Clinical Hospital of Timisoara, Clinic II Pediatrics, Timisoara, Romania
| | - Nelli Farkas
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- Institute of Bioanalysis, University of Pécs Medical School, Pécs, Hungary
| | - Péter Mátrai
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- Institute of Bioanalysis, University of Pécs Medical School, Pécs, Hungary
| | - Irina Cazacu
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- Research Center of Gastroenterology and Hepatology, Craiova, Romania
| | - Máté Ottóffy
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Tamás Habon
- Division of Cardiology, First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Àron Vincze
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Gábor Veres
- Department of Pediatrics, University of Debrecen, Debrecen, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Patrícia Sarlós
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Zoltán Rakonczay
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
- MTA–SZTE Momentum Translational Gastroenterology Research Group, University of Szeged, Szeged, Hungary
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Abaylı B, Gençdal G, Değirmencioğlu Ş. Correlation between neutrophil/lymphocyte ratio and Ranson score in acute pancreatitis. J Clin Lab Anal 2018; 32:e22437. [PMID: 29575044 PMCID: PMC6816873 DOI: 10.1002/jcla.22437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/01/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is characterized by inflammation of the pancreas, elevated pancreatic enzymes, and abdominal pain. The neutrophil to lymphocyte ratio (NLR) is used as a marker of inflammation. In this retrospective study, we aimed to investigate novel early prognostic predictors of AP, such as NLR and its correlation with the Ranson score. METHODS A total 435 patients (Male: 152; 34.9%, Age: 63.53 ± 17.22 years) were included in the study. Data were collected by two clinicians scanning the registered hospital records. RESULTS Classification of the patients according to the aetiologies revealed gallstone(s) 58.6% (n = 255), hyperlipidaemia 2.2% (n = 9), viruses 0.7% (n = 3), malignancies 0.5% (n = 2), and alcohol 0.2% (n = 1). No reason was discovered in 37.9% (n = 165) of patients. Age, duration in the intensive care unit, serum aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin, lactate dehydrogenase (LDH), white blood cell (WBC) count, neutrophil count, lymphocyte count, and the NLR were greater in the group with a Ranson score ≥3 than the group with a Ranson score <3. DISCUSSION Quick diagnosis is essential in AP. Current scoring systems for AP diagnosis are complicated, whereas NLP is a simple, practical, and effective marker.
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Affiliation(s)
- Bahri Abaylı
- Department of Gastroenterology and HepatologyCukurova Dr. Askım Tufekci HospitalAdanaTurkey
| | - Genco Gençdal
- Center of TransplantationDepartment of Gastroenterology and HepatologyYeni Yuzyıl, School of MedicineİstanbulTurkey
| | - Şerife Değirmencioğlu
- Department of Internal MedicineYeni Yüzyıl University School of MedicineIstanbulTurkey
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Qu J, Yang JZ. Value of neutrophil to lymphocyte ratio combined with red blood cell distribution width for predicting severity of acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2018; 26:1119-1124. [DOI: 10.11569/wcjd.v26.i18.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the value of neutrophil to lymphocyte ratio (NLR) combined with red blood cell distribution width (RDW) for predicting the severity of acute pancreatitis (AP).
METHODS The clinical data of 120 patients with AP were retrospectively analyzed in this study. The patients were assigned to three groups: mild AP (MAP) group, moderately severe AP (MSAP) group, and severe AP (SAP) group. The clinical indexes (NLR and RDW) of the three groups of patients were measured at 24 h after hospitalization. All of these data were compared among the groups, and between dead patients and surviving cases. The receiver operator characteristic curves (ROCs) of NLR, RDW, and NLR plus RDW were plotted to assess their value in predicting the prognosis of AP.
RESULTS With the increase of the severity of AP, the value of NLR increased significantly (P < 0.05). There was no significant difference in RDW between the MAP and MSAP groups (P > 0.05). The RDW value of the SAP group was significantly different from those of the MAP and MSAP groups (P < 0.05). The values of NLR and RDW in the death group were significantly higher than those in the survival group (P < 0.05). The area under the curve of NLR in predicting AP severity was 0.794, which was significantly higher than that of RDW (0.745; P < 0.05). The area under the NLR + RDW curve was 0.876 (sensitivity, 0.795; specificity, 0.852), which was significantly higher than that of NLR and RDW alone (P < 0.05).
CONCLUSION NLR and RDW are both related to the severity of AP, and the combination of the two indexes can improve the sensitivity and specificity of predicting the severity of AP.
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Affiliation(s)
- Juan Qu
- Department of Gastroenterology, Nankai Hospital, Tianjin 300100, China
| | - Ji-Zhi Yang
- Department of Traditional Chinese Medicine, Chentangzhuang Hospital of Hexi District, Tianjin 300222, China
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Park KS, Lee SH, Yun SJ, Ryu S, Kim K. Neutrophil-to-lymphocyte ratio as a feasible prognostic marker for pyogenic liver abscess in the emergency department. Eur J Trauma Emerg Surg 2018; 45:343-351. [PMID: 29480320 DOI: 10.1007/s00068-018-0925-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/21/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The neutrophil-to-lymphocyte ratio (NLR) is an effective predictor of mortality in patients with for various conditions. To date, there are no previous studies on NLR as a prognostic marker for pyogenic liver abscess (PLA), especially on admission to the emergency department (ED). METHODS From January 2013 to December 2015, 102 patients diagnosed with PLA in the ED were included. Clinico-radiological and laboratory results, including NLR, were evaluated as variables. NLR was calculated as absolute neutrophil count/absolute lymphocyte count. To evaluate the prognosis of PLA, data on hospital mortality, intensive care unit (ICU) admission, and development of septic shock were obtained. Multivariate logistic regression analyses and receiver-operating characteristic (ROC) curve analysis were performed. RESULTS Among 102 patients, 10 (9.8%) died, 14 (13.7%) were admitted to the ICU, and 15 (14.7%) developed septic shock during hospitalization. Multivariate logistic regression analysis revealed NLR as an independent factor in predicting death [odds ratio (OR), 1.4; p = 0.020], ICU admission (OR, 1.4; p = 0.021), and development of septic shock (OR, 1.6; p = 0.041). NLR showed an excellent predictive performance for death (areas under the ROC curves [AUC], 0.941; cut-off value, 19.7; p < 0.001), ICU admission (AUC, 0.946; cut-off value, 16.9; p < 0.001), and development of septic shock (AUC, 0.927; cut-off value, 16.9; p < 0.001). CONCLUSION NLR was positively associated with poor prognosis of PLA; elevated NLR could predictor of high risk of death, ICU admission, and development of septic shock. Emergency physicians should consider NLR for the prognosis of PLA and early aggressive treatment, especially in patients with NLR > 16.9.
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Affiliation(s)
- Kwang Soon Park
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-Gu, Seoul, 05278, Republic of Korea.
| | - Seokyong Ryu
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Keon Kim
- Department of Emergency Medicine, Ewha Womans University Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
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Cho SK, Jung S, Lee KJ, Kim JW. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis. BMC Gastroenterol 2018; 18:18. [PMID: 29370777 PMCID: PMC5785858 DOI: 10.1186/s12876-018-0748-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/18/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) predict severity in various diseases. In this study, we evaluated the value of NLR and PLR as prognostic factors in acute pancreatitis (AP). METHODS Patients with AP were prospectively enrolled from March 2014 to September 2016 at Yonsei University Wonju College of Medicine. NLR and PLR were obtained at admission and were compared with other known prognostic scoring systems. RESULTS A total of 243 patients were enrolled with an etiology of gallstone (n = 134) or alcohol (n = 109). NLR (17.7 ± 18.3 vs. 8.8 ± 8.4, P < 0.001) and PLR (344.1 ± 282.6 vs. 177.8 ± 150.1, P < 0.001) were significantly higher in the gallstone AP group than in the alcoholic AP group. For gallstone AP, NLR and PLR were significantly higher in severe AP, whereas high NLR and PLR were not related to severe AP in alcoholic AP. For the gallstone AP group, NLR and PLR demonstrated a predictive value significantly superior to C-reactive protein (CRP), whereas NLR, PLR, and CRP were not significant predictors for alcoholic AP. CONCLUSION Our study demonstrated that NLR and PLR can predict the severity of AP, but only in gallstone AP.
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Affiliation(s)
- Seung Kook Cho
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, 26426, Republic of Korea
| | - Saehyun Jung
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, 26426, Republic of Korea
| | - Kyong Joo Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, 26426, Republic of Korea.
| | - Jae Woo Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, 26426, Republic of Korea.
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Fonteh P, Smith M, Brand M. Adaptive Immune Cell Dysregulation and Role in Acute Pancreatitis Disease Progression and Treatment. Arch Immunol Ther Exp (Warsz) 2017; 66:199-209. [PMID: 29189884 DOI: 10.1007/s00005-017-0495-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/31/2017] [Indexed: 12/18/2022]
Abstract
Acute pancreatitis (AP) is an inflammation of the pancreas caused by various stimuli including excessive alcohol consumption, gallstone disease and certain viral infections. Managing specifically the severe form of AP is limited due to lack of an understanding of the complex immune events that occur during AP involving immune cells and inflammatory molecules such as cytokines. The relative abundance of various immune cells resulting from the immune dysregulation drives disease progression. In this review, we examine the literature on the adaptive immune cells in AP, the prognostic value of these cells in stratifying patients into appropriate care and treatment strategies based on cell frequency in different AP severities are discussed.
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Affiliation(s)
- Pascaline Fonteh
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Martin Smith
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Martin Brand
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
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Multi-institutional analysis of neutrophil-to-lymphocyte ratio (NLR) in patients with severe hemorrhage: A new mortality predictor value. J Trauma Acute Care Surg 2017; 83:888-893. [PMID: 28837540 DOI: 10.1097/ta.0000000000001683] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The neutrophil/lymphocyte ratio (NLR) has been associated as a predictor for increased mortality in critically ill patients. We sought to determine the relationship between NLR and outcomes in adult trauma patients with severe hemorrhage requiring the initiation of massive transfusion protocol (MTP). We hypothesized that the NLR would be a prognostic indicator of mortality in this population. METHODS This was a multi-institutional retrospective cohort study of adult trauma patients (≥18 years) with severe hemorrhage who received MTP between November 2014 and November 2015. Differentiated blood cell counts obtained at days 3 and 10 were used to obtain NLR. Receiver operating characteristic (ROC) curve analysis assessed the predictive capacity of NLR on mortality. To identify the effect of NLR on survival, Kaplan-Meier (KM) survival analysis and Cox regression models were used. RESULTS A total of 285 patients with severe hemorrhage managed with MTP were analyzed from six participating institutions. Most (80%) were men, 57.2% suffered blunt trauma. Median (IQR) age, Injury Severity Score, and Glasgow Coma Scale were 35 (25-47), 25 (16-36), and 9 (3-15), respectively. Using ROC curve analysis, optimal NLR cutoff values of 8.81 at day 3 and 13.68 at day 10 were calculated by maximizing the Youden index. KM curves at day 3 (p = 0.05) and day 10 (p = 0.02) revealed an NLR greater than or equal to these cutoff values as a marker for increased in-hospital mortality. Cox regression models failed to demonstrate an NLR over 8.81 as predictive of in-hospital mortality at day 3 (p = 0.056) but was predictive for mortality if NLR was greater than 13.68 at day 10 (p = 0.036). CONCLUSIONS NLR is strongly associated with early mortality in patients with severe hemorrhage managed with MTP. Further research is needed to focus on factors that can ameliorate NLR in this patient population. LEVEL OF EVIDENCE Prognostic study, level III.
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Wang Y, Fuentes HE, Attar BM, Jaiswal P, Demetria M. Evaluation of the prognostic value of neutrophil to lymphocyte ratio in patients with hypertriglyceridemia-induced acute pancreatitis. Pancreatology 2017; 17:893-897. [PMID: 29030078 DOI: 10.1016/j.pan.2017.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/23/2017] [Accepted: 10/03/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Recent studies attribute promising prognostic values to various inflammatory biomarkers in acute pancreatitis, including the following: the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW). We aimed to determine the performance of these biomarkers for detecting disease severity in patients with hypertriglyceridemia-induced acute pancreatitis (HTG-AP). METHODS We retrospectively reviewed 110 patients with HTG-AP and compared the NLR, PLR, and RDW in different severity groups. We performed receiver-operating characteristic (ROC) analysis to identify the optimal cut-off value for NLR to predict severe AP. RESULTS NLR was significantly higher in patients with severe AP than mild and moderately severe AP (14.6 vs. 6.9, p < 0.001), and higher with organ failure upon presentation (9.1 vs. 7.1, p = 0.026). After dichotomization by the optimal cut-off value of 10 as determined by the ROC curve, the high-NLR group had a significantly longer length of stay (9.1 vs. 6.6 days, p = 0.001), duration of nil per os (4.9 vs. 3.7 days, p = 0.007), and higher rates of complications, including systemic inflammatory response syndrome (81.5% vs. 44.6%, p = 0.001) and persistent acute kidney injury (25.9% vs. 3.6%, p < 0.001). High NLR independently predicted severe acute pancreatitis in multivariate analysis (Odds ratio 6.71, p = 0.019). CONCLUSION NLR represents an inexpensive, readily available test with a promising value to predict disease severity in HTG-AP. Among the three inflammatory biomarkers, NLR has the highest discriminatory capacity for severe HTG-AP, with an optimal cut-off value of 10.
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Affiliation(s)
- Yuchen Wang
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, United States.
| | - Harry E Fuentes
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, United States
| | - Bashar M Attar
- Department of Gastroenterology, Rush University Medical Center, Chicago, IL, United States; Division of Gastroenterology and Hepatology, John H Stroger Hospital of Cook County, Chicago, IL, United States
| | - Palash Jaiswal
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, United States
| | - Melchor Demetria
- Division of Gastroenterology and Hepatology, John H Stroger Hospital of Cook County, Chicago, IL, United States
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Zhang Y, Guo F, Li S, Wang F, Meng Z, Zhao J, Liu Z, Wang B, Fan P, Wang C, Wu H. Decreased high density lipoprotein cholesterol is an independent predictor for persistent organ failure, pancreatic necrosis and mortality in acute pancreatitis. Sci Rep 2017; 7:8064. [PMID: 28808236 PMCID: PMC5556036 DOI: 10.1038/s41598-017-06618-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/19/2017] [Indexed: 12/15/2022] Open
Abstract
High density lipoprotein cholesterol (HDL-C) has been reported as a significant indicator of systemic inflammation. The association underlying HDL-C and persistent organ failure (POF), pancreatic necrosis (PNec) and mortality in acute pancreatitis (AP) has not been evaluated. From 2007 to 2016, consecutive AP patients with admission lipid profiles assessment were included in this study. The association of HDL-C value and other lipids with outcomes was explored with Cox proportional regression models, which were adjusted for confounding factors. 1131 consecutive AP patients were clinically eligible. Overall, 17.9% of the patients developed with POF, 27.1% experienced PNec, and 6.7% died during hospitalization. Lower HDL-C median (<1.06 mmol/L) was identified as an independent prognostic factor of the outcomes. Moreover, there was a positive trend for the association across increasing HDL-C quartiles and POF, PNec and mortality after multivariable analysis (p values were <0.001, <0.001 and 0.043, respectively). The AUC of HDL-C for the outcomes were comparable to that of Ranson score for diagnosing POF (0.778 vs. 0.678; P < 0.001), PNec (0.734 vs. 0.701; P = 0.143) and mortality (0.768 vs. 0.745; P = 0.516). Decreased HDL-C value is an independent risk factor for the incidence of POF, PNec and in-hospital mortality in AP.
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Affiliation(s)
- Yushun Zhang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Feng Guo
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shoukang Li
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Feiyang Wang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zibo Meng
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jingyuan Zhao
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhiqiang Liu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Bo Wang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Ping Fan
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Chunyou Wang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Heshui Wu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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Gao F, Sun L, Ye X, Liu Y, Liu H, Geng M, Li X, Yang X, Li Y, Wang R, Chen J, Wan G, Jiang Y, Wang X. Development and validation of a prognostic model for acute-on-chronic hepatitis B liver failure. Eur J Gastroenterol Hepatol 2017; 29:669-678. [PMID: 28195876 DOI: 10.1097/meg.0000000000000854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM The CANONIC study proposed the Chronic Liver Failure Consortium acute-on-chronic liver failure (CLIF-C ACLF) prognostic model at the European Association for the Study of the Liver-CLIF diagnosis. This study aimed to develop and validate a prognostic model for predicting the short-term mortality of hepatitis B virus (HBV) ACLF as defined by the Asia-Pacific Association for the Study of the Liver. PATIENTS AND METHODS A retrospective cohort of 381 HBV ACLF patients and a prospective cohort of 192 patients were included in this study. Independent predictors of disease progression were determined using univariate and multivariate Cox proportional hazard regression analysis, and a regression model for predicting prognosis was established. Patient survival was estimated by Kaplan-Meier analysis and subsequently compared by log-rank tests. The area under the receiver operating characteristic curve was used to compare the performance of various current prognostic models. RESULTS Our model was constructed with five independent risk factors: hepatic encephalopathy, international normalized ratio, neutrophil-lymphocyte ratio, age, and total bilirubin, termed as the HINAT ACLF model, which showed the strongest predictive values compared with CLIF-C ACLF, CLIF-C Organ Failure, Sequential Organ Failure Assessment, CLIF-Sequential Organ Failure Assessment, Model for End-stage Liver Disease, Model for End-stage Liver Disease-sodium, and Child-Turcotte-Pugh scores; this model reduced the corresponding prediction error rates at 28 and 90 days by 16.4-54.5% after ACLF diagnosis in both the derivation cohort and the validation cohorts. CONCLUSION The HINAT ACLF model can accurately predict the short-term mortality of patients with HBV ACLF as defined by Asia-Pacific Association for the Study of the Liver.
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Affiliation(s)
- Fangyuan Gao
- aCenter of Integrative Medicine bStatistics Room, Beijing Ditan Hospital, Capital Medical University cDepartment of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Chen C, Huang Z, Li H, Song B, Yuan F. Evaluation of extrapancreatic inflammation on abdominal computed tomography as an early predictor of organ failure in acute pancreatitis as defined by the revised Atlanta classification. Medicine (Baltimore) 2017; 96:e6517. [PMID: 28403081 PMCID: PMC5403078 DOI: 10.1097/md.0000000000006517] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of the study was to determine whether extrapancreatic inflammation on computed tomography (EPIC) is helpful in predicting organ failure in the early phase of acute pancreatitis (AP) as defined by the 2012 revised Atlanta classification.Patients (n = 208) who underwent abdominal computed tomography (CT) within 24 hours after AP onset and admission were retrospectively identified. Each patient's EPIC score, Balthazar score, bedside index of severity in acute pancreatitis (BISAP), and systemic inflammatory response syndrome (SIRS) score were obtained. Primary endpoints were organ failure occurrence and death. Scores were evaluated by receiver operator characteristic (ROC) curve and area under the curve (AUC) analysis.Median age was 45 years (range: 18-83 years). Forty-seven patients (22.6%) developed organ failure, and 5 patients (2.4%) developed infection and underwent surgery. Two patients died. The median EPIC score was 2 (range: 0-7). EPIC score accuracy (AUC = 0.724) in predicting organ failure was similar to that of BISAP (0.773) and SIRS (0.801) scores, whereas Balthazar scoring was not significant (P = .293). An EPIC score of 3 or greater had a sensitivity and specificity of 80.65% and 63.16%, respectively. EPIC scores correlated moderately with organ failure severity (Spearman r = 0.321) and number of failed organs (r = 0.343).The EPIC scoring system can be useful in predicting the occurrence of organ failure, but it does not differentiate severity and number of failed organs in early phase AP.
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