Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study

Yuanyuan Li, Ying Zhao, Limin Feng, Renyong Guo, Yuanyuan Li, Ying Zhao, Limin Feng, Renyong Guo

Abstract

Objectives: Inflammation-based prognostic markers (neutrophil-lymphocyte ratio (NLR), prognostic nutritional index (PNI), red cell distribution width (RDW) and lymphocyte-monocyte ratio (LMR)) are associated with overall survival in some diseases. This study assessed their prognostic value in mortality and severity in acute pancreatitis (AP).

Design: A retrospective cohort study.

Setting: Patients with AP were recruited from the emergency department at our hospital.

Participants: A total of 359 patients with AP (31 non-survivors) were enrolled.

Primary and secondary outcome measures: Mortality and severity of AP were the primary and secondary outcome measures, respectively. Biochemistry and haematology results of the first test after admission were collected. Independent relationships between severe AP (SAP) and markers were assessed using multivariate logistic regression models. Mortality prediction ability was evaluated using receiver operating characteristic (ROC) curves. Overall survival was evaluated using the Kaplan-Meier method, with differences compared using the log-rank test. Independent relationships between mortality and each predictor were estimated using the Cox proportional hazard models.

Results: Compared with survivors of AP, non-survivors had higher RDW (p<0.001), higher NLR (p<0.001), lower LMR (p<0.001) and lower PNI (p<0.001) at baseline. C reactive protein (CRP; OR=8.251, p<0.001), RDW (OR=2.533, p=0.003) and PNI (OR=7.753, p<0.001) were independently associated with the occurrence of SAP. For predicting mortality, NLR had the largest area under the ROC curve (0.804, p<0.001), with a 16.64 cut-off value, 82.4% sensitivity and 75.6% specificity. RDW was a reliable marker for excluding death owing to its lowest negative likelihood ratio (0.11). NLR (HR=4.726, p=0.004), CRP (HR=3.503, p=0.003), RDW (HR=3.139, p=0.013) and PNI (HR=2.641, p=0.011) were independently associated with mortality of AP.

Conclusions: NLR was the most powerful marker of overall survival in this patient series.

Keywords: acute pancreatitis; mortality; neutrophil-lymphocyte ratio; prognostic nutritional index.

Conflict of interest statement

Competing interests: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
ROC curves analysis for predicting mortality by NLR and combined markers in the estimation cohort. ROC, receiver operating characteristic; NLR, neutrophil–lymphocyte ratio; PNI, prognostic nutritional index; RDW, red cell distribution width.
Figure 2
Figure 2
Relationship between inflammation-based prognostic markers and overall survival in patients with acute pancreatitis. A, B, C, D and E show the relationship between NLR, CRP, RDW, PNI and LMR, and overall survival in patients with acute pancreatitis, respectively. CRP, C reactive protein; LMR, lymphocyte–monocyte ratio; NLR, neutrophil–lymphocyte ratio; PNI, prognostic nutritional index; RDW, red cell distribution width.

References

    1. Banks PA, Bollen TL, Dervenis C et al. . Classification of acute pancreatitis—2012: revision. The diagnosis of acute pancreatitis requires two of the following three features: and definitions by international consensus. Gut 2013;62:102–11. 10.1136/gutjnl-2012-302779
    1. Maheshwari R, Subramanian RM. Severe acute pancreatitis and necrotizing pancreatitis. Crit Care Clin 2016;32:279–90. 10.1016/j.ccc.2015.12.006
    1. Bugiantella W, Rondelli F, Boni M et al. . Necrotizing pancreatitis: a review of the interventions. Int J Surg 2016;28(Suppl 1):S163–71. 10.1016/j.ijsu.2015.12.038
    1. Petrov MS, Shanbhag S, Chakraborty M et al. . Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology 2010;139:813–20. 10.1053/j.gastro.2010.06.010
    1. Dellinger EP, Forsmark CE, Layer P et al. . Determinant-based classification of acute pancreatitis severity: an international multidisciplinary consultation. Ann Surg 2012;256:875–80. 10.1097/SLA.0b013e318256f778
    1. Papachristou GI, Muddana V, Yadav D et al. . Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol 2010;105:435–41; quiz 42 10.1038/ajg.2009.622
    1. Mounzer R, Langmead CJ, Wu BU et al. . Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology 2012;142:1476–82; quiz e15–6 10.1053/j.gastro.2012.03.005
    1. Bezmarevic M, Mirkovic D, Soldatovic I et al. . Correlation between procalcitonin and intra-abdominal pressure and their role in prediction of the severity of acute pancreatitis. Pancreatology 2012;12:337–43. 10.1016/j.pan.2012.05.007
    1. Yang CJ, Chen J, Phillips AR et al. . Predictors of severe and critical acute pancreatitis: a systematic review. Dig Liver Dis 2014;46:446–51. 10.1016/j.dld.2014.01.158
    1. Hunziker S, Celi LA, Lee J et al. . Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients. Crit Care 2012;16:R89 10.1186/cc11351
    1. Kinoshita A, Onoda H, Imai N et al. . Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma. Br J Cancer 2012;107:988–93. 10.1038/bjc.2012.354
    1. Teng JJ, Zhang J, Zhang TY et al. . Prognostic value of peripheral blood lymphocyte-to-monocyte ratio in patients with solid tumors: a meta-analysis. Onco Targets Ther 2016;9:37–47. 10.2147/OTT.S94458
    1. Chen L, Lou Y, Chen Y et al. . Prognostic value of the neutrophil-to-lymphocyte ratio in patients with acute-on-chronic liver failure. Int J Clin Pract 2014;68:1034–40. 10.1111/ijcp.12408
    1. Smith RA, Bosonnet L, Raraty M et al. . Preoperative platelet-lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductal adenocarcinoma. Am J Surg 2009;197:466–72. 10.1016/j.amjsurg.2007.12.057
    1. Proctor MJ, Morrison DS, Talwar D et al. . An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer 2011;104:726–34. 10.1038/sj.bjc.6606087
    1. Proctor MJ, Morrison DS, Talwar D et al. . A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer 2011;47:2633–41. 10.1016/j.ejca.2011.03.028
    1. Zampieri FG, Ranzani OT, Sabatoski V et al. . An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients. Ann Intensive Care 2014;4:20 10.1186/s13613-014-0020-1
    1. Yao J, Lv G. Association between red cell distribution width and acute pancreatitis: a cross-sectional study. BMJ Open 2014;4:e004721 10.1136/bmjopen-2013-004721
    1. Suppiah A, Malde D, Arab T et al. . The prognostic value of the neutrophil-lymphocyte ratio (NLR) in acute pancreatitis: identification of an optimal NLR. J Gastrointest Surg 2013;17:675–81. 10.1007/s11605-012-2121-1
    1. Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 1993;39:561–77.
    1. Altman DG, Bland JM. Diagnostic tests 3: receiver operating characteristic plots. BMJ 1994;309:188.
    1. Felderbauer P, Muller C, Bulut K et al. . Pathophysiology and treatment of acute pancreatitis: new therapeutic targets--a ray of hope? Basic Clin Pharmacol Toxicol 2005;97:342–50. 10.1111/j.1742-7843.2005.pto_274.x
    1. Xue J, Sharma V, Habtezion A. Immune cells and immune-based therapy in pancreatitis. Immunol Res 2014;58:378–86. 10.1007/s12026-014-8504-5
    1. Zhu L, Chen G, Xia Q et al. . Use of band cell percentage as an early predictor of death and ICU admission in severe acute pancreatitis. Hepatogastroenterology 2010;57:1543–8.
    1. Zahorec R. Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102:5–14.
    1. de Jager CP, van Wijk PT, Mathoera RB et al. . Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care 2010;14:R192 10.1186/cc9309
    1. Le Tulzo Y, Pangault C, Gacouin A et al. . Early circulating lymphocyte apoptosis in human septic shock is associated with poor outcome. Shock 2002;18:487–94.
    1. Takeyama Y, Takas K, Ueda T et al. . Peripheral lymphocyte reduction in severe acute pancreatitis is caused by apoptotic cell death. J Gastrointest Surg 2000;4:379–87.
    1. Pezzilli R, Billi P, Beltrandi E et al. . Circulating lymphocyte subsets in human acute pancreatitis. Pancreas 1995;11:95–100.
    1. McKay C, Imrie CW, Baxter JN. Mononuclear phagocyte activation and acute pancreatitis. Scand J Gastroenterol Suppl 1996;219:32–6.
    1. Saeki K, Kanai T, Nakano M et al. . CCL2-induced migration and SOCS3-mediated activation of macrophages are involved in cerulein-induced pancreatitis in mice. Gastroenterology 2012;142:1010–20.e9. 10.1053/j.gastro.2011.12.054
    1. Binnetoglu E, Akbal E, Gunes F et al. . The prognostic value of neutrophil-lymphocyte ratio in acute pancreatitis is controversial. J Gastrointest Surg 2014;18:885 10.1007/s11605-013-2435-7
    1. Gonzalvez-Gasch A, de Casasola GG, Martin RB et al. . A simple prognostic score for risk assessment in patients with acute pancreatitis. Eur J Intern Med 2009;20:e43–8. 10.1016/j.ejim.2008.09.014
    1. Chen Y, Zhang ZW, Wang B et al. . Relationship between early serum albumin variation and prognosis in patients with severe acute pancreatitis treated in ICU. Sichuan Da Xue Xue Bao Yi Xue Ban 2013;44:237–41.
    1. Pinato DJ, North BV, Sharma R. A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI). Br J Cancer 2012;106:1439–45. 10.1038/bjc.2012.92
    1. Lappegard J, Ellingsen TS, Vik A et al. . Red cell distribution width and carotid atherosclerosis progression. The Tromso Study. Thromb Haemost 2015;113:649–54.
    1. Bekler A, Tenekecioglu E, Erbag G et al. . Relationship between red cell distribution width and long-term mortality in patients with non-ST elevation acute coronary syndrome. Anatol J Cardiol 2015;15:634–9. 10.5152/akd.2014.5645
    1. Salvagno GL, Sanchis-Gomar F, Picanza A et al. . Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2015;52:86–105. 10.3109/10408363.2014.992064

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться