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

doi:10.3877/cma.j.issn.2095-2015.2023.06.014

Abstract

Abstract:

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.

Key words: Acute pancreatitis, Red blood cell distribution width, Bedside index of severity in acute pancreatitis, Mortality

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]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 433-438.

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Figures/Tables 4

References 30

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变量	例数(n＝321)	严重程度		统计量	P值
变量	例数(n＝321)	非SAP(n＝261)	SAP(n＝60)	统计量	P值
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

变量	例数(n＝321)	严重程度		统计量	P值
变量	例数(n＝321)	非SAP(n＝261)	SAP(n＝60)	统计量	P值
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

因素	单因素logistic分析		多因素logistic分析
因素	HR及95% CI	P值	HR及95% CI	P值
年龄	0.997(0.959~1.035)	0.858
性别(男)	2.245(0.620~8.127)	0.218
病因(胆石性)	0.898(0.318~2.538)	0.839
体温	0.675(0.272~1.675)	0.396
心率	1.037(1.014~1.061)	0.002	1.000(0.963~1.039)	0.994
呼吸频率	1.150(1.058~1.249)	0.001	1.096(0.946~1.269)	0.221
收缩压	1.001(0.975~1.027)	0.949
白细胞计数	1.090(0.990~1.199)	0.078
血小板计数	0.997(0.990~1.005)	0.997
红细胞比容	1.099(1.014~1.190)	0.022	1.105(0.984~1.240)	0.093
RDW/ALB	1.095(1.047~1.145)	<0.001	1.103(1.048~1.161)	<0.001
总胆红素	1.004(0.988~1.019)	0.654
AST	1.002(0.999~1.004)	0.177
ALT	0.999(0.994~1.004)	0.785
血尿素氮	1.136(1.068~1.209)	<0.001	1.075(0.996~1.160)	0.063
血肌酐	1.003(1.000~1.006)	0.023	0.997(0.989~1.004)	0.343
血钠	0.916(0.821~1.022)	0.916
血钾	2.641(1.530~4.558)	<0.001	2.131(0.905~5.019)	0.084
血钙	0.164(0.049~0.551)	0.003	1.621(0.231~11.370)	0.627
血糖	1.116(1.038~1.199)	0.003	1.081(1.005~1.162)	0.037
血淀粉酶	1.000(0.999~1.003)	0.627
C反应蛋白	1.168(1.050~1.561)	0.001	1.540(0.022~2.132)	0.222
BISAP评分	2.209(1.496~3.262)	<0.001	2.039(1.235~3.369)	0.005

因素	单因素logistic分析		多因素logistic分析
因素	HR及95% CI	P值	HR及95% CI	P值
年龄	0.997(0.959~1.035)	0.858
性别(男)	2.245(0.620~8.127)	0.218
病因(胆石性)	0.898(0.318~2.538)	0.839
体温	0.675(0.272~1.675)	0.396
心率	1.037(1.014~1.061)	0.002	1.000(0.963~1.039)	0.994
呼吸频率	1.150(1.058~1.249)	0.001	1.096(0.946~1.269)	0.221
收缩压	1.001(0.975~1.027)	0.949
白细胞计数	1.090(0.990~1.199)	0.078
血小板计数	0.997(0.990~1.005)	0.997
红细胞比容	1.099(1.014~1.190)	0.022	1.105(0.984~1.240)	0.093
RDW/ALB	1.095(1.047~1.145)	<0.001	1.103(1.048~1.161)	<0.001
总胆红素	1.004(0.988~1.019)	0.654
AST	1.002(0.999~1.004)	0.177
ALT	0.999(0.994~1.004)	0.785
血尿素氮	1.136(1.068~1.209)	<0.001	1.075(0.996~1.160)	0.063
血肌酐	1.003(1.000~1.006)	0.023	0.997(0.989~1.004)	0.343
血钠	0.916(0.821~1.022)	0.916
血钾	2.641(1.530~4.558)	<0.001	2.131(0.905~5.019)	0.084
血钙	0.164(0.049~0.551)	0.003	1.621(0.231~11.370)	0.627
血糖	1.116(1.038~1.199)	0.003	1.081(1.005~1.162)	0.037
血淀粉酶	1.000(0.999~1.003)	0.627
C反应蛋白	1.168(1.050~1.561)	0.001	1.540(0.022~2.132)	0.222
BISAP评分	2.209(1.496~3.262)	<0.001	2.039(1.235~3.369)	0.005

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