摘要
目的在重症急性胰腺炎(severe acute pancreatitis,SAP)是否并发持续炎症-免疫抑制-分解代谢综合征(PICS)中探讨中性粒细胞与淋巴细胞计数比值(NLR)联合纤维蛋白降解产物(FDP)与D-二聚体比值等指标的临床预测效能,并构建预测模型。方法回顾性收集2018年5月至2023年5月安徽医科大学第一附属医院重症医学科、急诊医学科、消化内科入住的133例SAP患者的临床资料。根据PICS诊断标准将其分为SAP并发PICS组(60例)和SAP非并发PICS组(73例),对两组间NLR、FDP与D-二聚体比值及常见临床指标进行回顾性分析;比较两组患者临床特征、重症监护病房(ICU)病死率及随访1年后生存率。采用Lasso回归及多因素Logistic回归筛选出独立危险因素,构建列线图预测模型。采用受试者工作特征(ROC)曲线、校准曲线对模型进行内部验证;采用临床决策曲线分析(DCA)评估模型的临床实用性。结果与SAP非并发PICS组比较,SAP并发PICS组的改良Marshall评分、NLR、血小板计数与淋巴细胞计数比值(PLR)及FDP与D-二聚体比值均明显升高(P<0.05);SAP并发PICS组合并血流感染及腹腔感染比例明显高于SAP非并发PICS组(P<0.05);通过多因素Logistic回归分析发现,NLR、FDP与D-二聚体比值是SAP并发PICS的独立危险因素(OR分别为0.790、0.131,P均<0.05)。Lasso回归筛选的预测变量得到三因素逻辑回归模型,预测变量包括FDP/D-二聚体、NLR、C反应蛋白(CRP)/前白蛋白(OR分别为1.981、1.048、4.726,P均<0.05)。将上述因素进行模型拟合,经bootstrap内部验证列线图模型曲线下面积(AUC)为0.948(95%CI 0.909~0.980)。校准曲线接近参考曲线,且DCA显示预测模型具有良好临床实用性。结论基于NLR、FDP与D-二聚体比值、CRP/前白蛋白构建SAP患者并发PICS风险列线图预测模型具备良好区分度、校准度和实用性。在SAP早期对是否并发PICS进行评估,若并发PICS,可能提示患者预后不良。
Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio(NLR)combined with fibrinogen degradation product(FDP)/D-dimer ratio in the patients with severe acute pancreatitis(SAP)complicated or not by persistent inflammation-immunosuppression-catabolism syndrome(PICS)and to establish a prediction model.Methods The clinical data of 133 patients with SAP admitted to the intensive care unit,emergency medicine and gastroenterology departments of the First Affiliated Hospital of Anhui Medical University from May 2018 to May 2023 were retrospectively analyzed.Based on the PICS diagnostic criteria,the patients were divided into two groups:the SAP with PICS group(60 cases)and the SAP without PICS group(73 cases).The difference in NLR,FDP/D-dimer ratio and common clinical indicators between the two groups were statistically analyzed.Relevant clinical features,ICU mortality and survival rate after a one-year follow-up were compared between the two groups.Independent risk factors were identified by using Lasso regression and multivariate Logistic regression.A nomogram prediction model was constructed and was internally validated by using the receiver operating characteristic(ROC)curve and calibration curve.The clinical applicability of the model was evaluated by using a clinical decision curve analysis(DCA).Results Compared with SAP without PICS group,the SAP with PICS group had significantly higher modified Marshall scores,NLR,platelet-to-lymphocyte ratio(PLR)and FDP/D-dimer ratio(all P<0.05).The proportion of bloodstream infection and abdominal infection was significantly higher in the SAP with PICS group than in the SAP without PICS group(P<0.05).Multivariate Logistic regression analysis showed that NLR and FDP/D-dimer ratio were the independent risk factors for SAP with PICS(OR=0.790 and 0.131,P<0.05).A three-factor Logistic regression model was developed by using predictor variables selected by Lasso regression.The predictor variables included FDP/D-dimer,NLR and C-reactive protein(CRP)/prealbumin(OR=1.981,1.048 and 4.726,respectively,all P<0.05).The model was fitted by using above factors,the area under curve(AUC)of the nomogram model was 0.948(95%CI 0.909-0.980)after internal validation with the bootstrap method.The calibration curve closely approximated the reference curve,and the clinical DCA indicated that the prediction model has good clinical applicability.Conclusions The nomogram prediction model constructed based on the NLR,FDP/D-dimer and CRP/prealbumin has discrimination,calibration and practicality in the patients of SAP complicated by PICS.These ratios can be used to evaluate whether the patients with SAP are likely to develop PICS,which may indicate a poor prognosis for the patients of SAP complicated by PICS.
作者
郑云
涂倩倩
张阿芳
张泓
Zheng Yun;Tu Qianqian;Zhang Afang;Zhang Hong(Department of Emergency,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《中国急救医学》
CAS
CSCD
2024年第10期890-896,共7页
Chinese Journal of Critical Care Medicine
基金
安徽省高校自然科学研究项目(2023AH040079)。
