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中华消化病与影像杂志(电子版) ›› 2023, Vol. 13 ›› Issue (06) : 433 -438. doi: 10.3877/cma.j.issn.2095-2015.2023.06.014

论著

红细胞分布宽度-白蛋白比值联合BISAP评分对急性胰腺炎严重程度及死亡率的预测价值
吉茜茜(), 田尧, 马林, 钱进   
  1. 226600 江苏省,海安市人民医院消化内科
  • 收稿日期:2023-05-26 出版日期:2023-12-01
  • 通信作者: 吉茜茜
  • 基金资助:
    江苏省高层次卫生人才"六个一工程"拔尖人才科研项目(LGY201918)

Predictive value of red blood cell distribution width-to-albumin ratio combined with BISAP score for severity and mortality in acute pancreatitis

Qianqian Ji(), Yao Tian, Lin Ma, Jin Qian   

  1. Department of Gastroenterology, Hai′an People′s Hospital, Hai′an 226600, China
  • Received:2023-05-26 Published:2023-12-01
  • Corresponding author: Qianqian Ji
引用本文:

吉茜茜, 田尧, 马林, 钱进. 红细胞分布宽度-白蛋白比值联合BISAP评分对急性胰腺炎严重程度及死亡率的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2023, 13(06): 433-438.

Qianqian Ji, Yao Tian, Lin Ma, Jin Qian. Predictive value of red blood cell distribution width-to-albumin ratio combined with BISAP score for severity and mortality in acute pancreatitis[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 433-438.

目的

探讨红细胞分布宽度(RDW)与血清白蛋白(ALB)比值联合急性胰腺炎床边严重程度指数(BISAP)对急性胰腺炎(AP)严重程度及30 d死亡率的预测价值。

方法

对2017年1月至2022年7月海安市人民医院收治的321例AP患者进行回顾性分析,确定AP的严重程度。通过受试者工作特征(ROC)曲线比较RDW/ALB、BISAP评分及两者联合对AP严重程度及30 d死亡率的预测价值。

结果

重症急性胰腺炎(SAP)占所有患者的18.7%(60/321),30 d内总死亡率为4.7%(15/321)。SAP组患者心率、呼吸频率、血糖、血清AST、ALT、尿素氮、血肌酐、RDW、血淀粉酶及BISAP评分均显著高于非SAP组(P<0.05),而血小板计数、血钙浓度和ALB显著低于非SAP组(P<0.05)。ROC曲线展示BISAP评分、RDW/ALB及两者联合预测SAP的曲线下面积(AUC)分别为0.751(95% CI 0.681~0.822),0.792(95% CI 0.726~0.858)和0.826(95% CI 0.760~0.892)。BISAP评分、RDW/ALB及联合预测30 d内死亡率的AUC分别为0.836(95% CI 0.765~0.908)、0.816(95% CI 0.740~0.892)和0.879(95% CI 0.820~0.937)。

结论

RDW/ALB联合BISAP评分进一步提高了对AP严重程度及死亡风险的分层。

Objective

To evaluate the predictive value of red cell distribution width(RDW)-to-albumin(ALB)ratio combined with bedside index of severity in acute pancreatitis(BISAP)score for the severity and 30-day mortality in acute pancreatitis(AP).

Methods

A total of 321 AP patients admitted to Hai′an People′s Hospital from January 2017 to July 2022 were retrospectively analyzed, and the severity of AP was defined.The predictive values of RDW/ALB ratio, BISAP score and their combination for AP severity and 30-day mortality were evaluated by receiver operation characteristics(ROC)curves.

Results

Of 321 AP patients, 60(18.7%)had severe acute pancreatitis(SAP)and the total mortality within 30 days was 4.7%(15/321). Compared with non-SAP group, the heart rate, respiratory rate, blood glucose, serum AST, ALT, blood urea nitrogen, serum creatinine level, RDW, amylase and BISAP score were higher(P<0.05), while platelet count, serum calcium and ALB were significantly lower in SAP group(P<0.05). ROC curves showed that the area under curve(AUC)values of BISAP score, RDW/ALB ratio and their combination for identifying SAP were 0.751(95% CI: 0.681-0.822), 0.792(95% CI: 0.726-0.858)and 0.826(95% CI: 0.760-0.892), respectively.In terms of 30-day mortality prediction, the AUC values for BISAP score, RDW/ALB ratio and their combination were 0.836(95% CI: 0.765-0.908), 0.816(95% CI: 0.740-0.892)and 0.879(95% CI: 0.820-0.937), respectively.

Conclusion

RDW/ALB ratio combined with BISAP score can further improve the risk stratification of AP severity and mortality.

表1 基于急性胰腺炎严重程度比较两组研究人群的基线特征
变量 例数(n=321) 严重程度 统计量 P
非SAP(n=261) SAP(n=60)
年龄(岁) 46.0(39.0~58.0) 46.0(40.0~57.0) 47.0(38.0~64.0) -0.681 0.496
性别(男) 208(64.8) 166(63.6) 42(70.0) 0.876 0.349
病因       5.729 0.220
胆石性 158(49.2) 131(50.2) 27(45.0)    
酒精性 70(21.8) 57(21.8) 13(21.7)    
高脂血症 58(18.1) 48(18.4) 10(16.7)    
ERCP术后 14(4.4) 8(3.1) 6(10.0)    
特发性 21(6.5) 17(6.5) 4(6.7)    
生命体征          
体温(℃) 37.2±0.6 37.2±0.6 37.1±0.7 0.618 0.537
心率(次/min) 95.3±20.6 92.4±19.0 108.1±22.1 -5.597 <0.001
呼吸频率(次/min) 22.0±4.0 21.4±3.1 24.3±5.9 -5.318 <0.001
收缩压(mmHg) 126.2±20.0 125.7±18.5 128.6±25.7 -1.025 0.306
实验室检查          
白细胞计数(×109/L) 11.3(8.2~14.8) 11.3(8.0~14.8) 11.7(8.7~14.6) -0.550 0.582
血小板计数(×109/L) 166.0(125.0~210.0) 173.0(129.0~ 216.0) 142.0(100.0~ 185.0) -3.483 <0.001
红细胞比容(%) 39.8(36.3~43.9) 39.7(36.3~43.8) 39.9(36.1~44.3) -0.472 0.637
RDW(%) 13.2(12.8~13.9) 13.2(12.8~13.6) 13.8(13.2~15.0) -5.311 <0.001
血清白蛋白(g/L) 38.0(35.0~40.0) 38.0(36.0~40.0) 34.0(30.5~37.0) -6.116 <0.001
RDW/ALB 0.33(0.30~0.36) 0.32(0.30~0.35) 0.37(0.34~0.43) -7.060 <0.001
总胆红素(μmol/L) 20.1(13.9~31.0) 19.3(13.9~30.6) 24.4(14.8~37.1) -1.885 0.059
AST(U/L) 32.0(20.0~69.0) 28.0(19.0~62.0) 45.0(29.0~107.0) -3.147 0.002
ALT(U/L) 30.0(20.0~77.0) 29.0(19.0~86.0) 46.0(28.0~63.0) -2.275 0.023
血尿素氮(mmol/L) 4.5(3.4~7.0) 4.3(3.1~6.2) 6.9(4.4~11.8) -5.487 <0.001
血肌酐(μmol/L) 68.5(55.5~84.2) 65.8(54.3~79.7) 91.3(66.9~236.5) -5.999 <0.001
血钠(mmol/L) 138.0(135.0~ 141.1) 138.2(135.0~ 141.0) 137.0(133.5~ 141.6) -1.109 0.267
血钾(mmol/L) 4.1(3.8~4.4) 4.1(3.8~4.4) 4.1(3.8~5.0) -1.682 0.093
血钙(mmol/L) 2.09(1.87~2.21) 2.12(1.95~2.25) 1.87(1.52~2.08) -5.148 <0.001
血糖(mmol/L) 8.0(6.3~10.8) 7.7(6.1~10.4) 9.4(7.2~13.8) -3.749 <0.001
血淀粉酶(U/L) 299(128~713) 281(117~685) 436(166~1041) -2.139 0.022
C反应蛋白(mg/L) 16.0(3.0~78.0) 16.2(3.0~77.0) 15.0(4.0~158.0) -0.816 0.414
BISAP评分 1.0(0~1.0) 0(0~1.0) 2.0(1.0~2.0) -6.543 <0.001
住院时间(d) 7.0(5.0~11.0) 6.0(4.0~8.0) 14.5(10.0~19.0) -8.686 <0.001
图1 ROC曲线展示BISAP评分、RDW/ALB及两者联合对急性胰腺炎严重程度的预测价值
表2 单、多变量logistic回归分析影响AP患者30 d死亡率的风险因素
图2 ROC曲线展示BISAP评分、RDW/ALB及两者联合对30 d死亡率的预测价值
1
Mederos MAReber HAGirgis MD.Acute Pancreatitis:A Review[J].JAMA2021325(4):382-390.
2
Boxhoorn LVoermans RPBouwense SA,et al.Acute pancreatitis[J].Lancet2020396(10252):726-734.
3
Banks PABollen TLDervenis C,et al.Classification of acute pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus[J].Gut201362(1):102-111.
4
王瑞,黄志寅,王默进,等.防治重症急性胰腺炎临床研究进展[J].中华内科杂志201655(6):490-493.
5
Crockett SFalck-Ytter YWani S,et al.Acute Pancreatitis Guideline[J].Gastroenterology2018154(4):1102.
6
Coluoglu IColuoglu EBinicier HC,et al.The role of the BISAP score in predicting acute pancreatitis severity according to the revised Atlanta classification:a single tertiary care unit experience from Turkey[J].Acta Gastroenterol Belg202184(4):571-576.
7
Gao WYang HXMa CE.The Value of BISAP Score for Predicting Mortality and Severity in Acute Pancreatitis:A Systematic Review and Meta-Analysis[J].PLoS One201510(6):e0130412.
8
Hines OJPandol SJ.Management of severe acute pancreatitis[J].BMJ2019367:l6227.
9
Lippi GPlebani M.Red blood cell distribution width(RDW)and human pathology.One size fits all[J].Clin Chem Lab Med201452(9):1247-1249.
10
Sim JHJang DMCho HS,et al.Association of red cell distribution width/albumin ratio with intraoperative blood transfusion in cervical cancer patients[J].PLoS One202217(11):e0277481.
11
Cheng KCLin YMLiu CC,et al.High Red Cell Distribution Width Is Associated with Worse Prognosis in Early Colorectal Cancer after Curative Resection:A Propensity-Matched Analysis[J].Cancers(Basel)202214(4).
12
Zhang FXLi ZLZhang ZD,et al.Prognostic value of red blood cell distribution width for severe acute pancreatitis[J].World J Gastroenterol201925(32):4739-4748.
13
Kim MLee CJKang HJ,et al.Red cell distribution width as a prognosticator in patients with heart failure[J].ESC Heart Fail2022.
14
Katamreddy AKokkinidis DGMiles J,et al.Elevated red cell distribution width and cardiovascular mortality in ASCVD risk cohorts:National Health and Nutrition Examination Survey(NHANES III)[J].Rev Cardiovasc Med202223(2):51.
15
Liu JHuang XYue S,et al.Association of Red Cell Distribution Width-to-Platelet Ratio and Mortality in Patients with Sepsis[J].Mediators Inflamm20222022:4915887.
16
Li SZhang YLi M,et al.Serum albumin,a good indicator of persistent organ failure in acute pancreatitis[J].BMC Gastroenterol201717(1):59.
17
Goyal HGupta SSingla U.Level of red cell distribution width is affected by various factors[J].Clin Chem Lab Med201654(12):e387.
18
Hagjer SKumar N.Evaluation of the BISAP scoring system in prognostication of acute pancreatitis-A prospective observational study[J].Int J Surg201854(Pt A):76-81.
19
Ouyang GPan GLiu Q,et al.The global,regional,and national burden of pancreatitis in 195 countries and territories,1990-2017:a systematic analysis for the Global Burden of Disease Study 2017[J].BMC Med202018(1):388.
20
Valverde-López FMatas-Cobos AMAlegría-Motte C,et al.BISAP,RANSON,lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort[J].J Gastroenterol Hepatol201732(9):1649-1656.
21
Zhang TLiu HWang D,et al.Predicting the Severity of Acute Pancreatitis With Red Cell Distribution Width at Early Admission Stage[J].Shock201849(5):551-555.
22
O′Connell RMBoland MRO′Driscoll J,et al.Red cell distribution width and neutrophil to lymphocyte ratio as predictors of outcomes in acute pancreatitis:A retrospective cohort study[J].Int J Surg201855:124-127.
23
Ganji AEsmaeilzadeh AGhanaei O,et al.Predictive value of red blood cell distribution width for mortality in patients with acute pancreatitis:A systematic review and meta-analysis[J].Med J Islam Repub Iran201731:124.
24
Gravito-Soares MGravito-Soares EGomes D,et al.Red cell distribution width and red cell distribution width to total serum calcium ratio as major predictors of severity and mortality in acute pancreatitis[J].BMC Gastroenterol201818(1):108.
25
Şenol KSaylam BKocaay F,et al.Red cell distribution width as a predictor of mortality in acute pancreatitis[J].Am J Emerg Med201331(4):687-689.
26
Lippi GTargher GMontagnana M,et al.Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients[J].Arch Pathol Lab Med2009133(4):628-632.
27
Artigas AWernerman JArroyo V,et al.Role of albumin in diseases associated with severe systemic inflammation:Pathophysiologic and clinical evidence in sepsis and in decompensated cirrhosis[J].J Crit Care201633:62-70.
28
Arroyo VGarcía-Martinez RSalvatella X.Human serum albumin,systemic inflammation,and cirrhosis[J].J Hepatol201461(2):396-407.
29
Yoo JWJu SLee SJ,et al.Red cell distribution width/albumin ratio is associated with 60-day mortality in patients with acute respiratory distress syndrome[J].Infect Dis(Lond)202052(4):266-270.
30
Wang XZhu LTao K,et al.Red cell distribution width to serum albumin ratio as an early prognostic marker for severe acute pancreatitis:A retrospective study[J].Arab J Gastroenterol202223(3):206-209.
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