Evaluation of scoring systems and hematological parameters in the severity stratification of early-phase acute pancreatitis

doi:10.3748/wjg.v31.i15.105236

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World Journal of Gastroenterology

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World J Gastroenterol. Apr 21, 2025; 31(15): 105236
Published online Apr 21, 2025. doi: 10.3748/wjg.v31.i15.105236

Table 1 Demographics and clinical profile in patients with acute pancreatitis, n (%)

Variables	MAP	MSAP	SAP	Total	P value
n	319	94	50	463
Age (years)	48.0 (36.0-60.0)	50.5 (37.0-73.3)	52.0 (37.8-71.8)	49.0 (37.0-63.0)	0.057
Gender
Male	209 (67.6)	66 (21.4)	34 (11.0)	309 (66.7)	0.683
Female	110 (71.4)	28 (18.2)	16 (10.4)	154 (33.3)	0.683
Etiology of AP
Gallstone	100 (21.6)	37 (8.0)	19 (4.1)	156 (33.7)	0.002^a
Alcohol	26 (5.6)	5 (1.1)	7 (1.5)	38 (8.2)
Hypertriglyceridemia	102 (22.0)	40 (8.6)	20 (4.3)	162 (35.0)
Others	91 (19.7)	12 (2.6)	4 (0.9)	107 (23.1)
BMI (kg/m²), mean ± SD	25.16 ± 3.89	25.49 ± 4.36	25.54 ± 4.07	25.27 ± 4.01	0.700
Smoking	135 (42.3)	45 (47.8)	21 (42.0)	201 (43.4)	0.620
Comorbidities
Diabetes mellitus	63 (19.7)	38 (40.4)	20 (40.0)	121 (26.1)	< 0.001^a
Hypertension	97 (30.4)	43 (45.7)	14 (28.0)	154 (33.3)	0.015^a
Coronary artery disease	11 (3.4)	8 (8.5)	5 (10.0)	24 (5.2)	0.027
Chronic kidney disease	6 (1.9)	3 (3.2)	1 (2.0)	10 (2.2)	0.684
Biliary tract disease	123 (38.6)	43 (45.7)	18 (36.0)	184 (39.7)	0.388
Healthy	104 (32.6)	18 (19.1)	10 (20.0)	132 (28.5)	0.015^a
Medical attention from symptom onset (hours)	17.0 (10.0-27.0)	22.0 (10.0-38.5)	17.0 (8.8-24.0)	18.0 (10.0-30.0)	0.182
Hospital stay (days)	7.0 (6.0-9.0)	10.0 (8.0-13.0)	18.0 (15.0-26.0)	8.0 (6.0-11.0)	< 0.001^a

^aP < 0.05.

AP: Acute pancreatitis; MAP: Mild acute pancreatitis; MSAP: Moderately severe acute pancreatitis; SAP: Severe acute pancreatitis; BMI: Body mass index.

Table 2 Basic characteristics in patients with acute pancreatitis

Variables	MAP	MSAP	SAP	P value
Variables	MAP	MSAP	SAP	All group	1 vs 2	2 vs 3
WCC (× 10⁹/L)	10.2 (7.90-12.70)	13.05 (9.80-16.25)	13.41 ± 4.51	< 0.001	< 0.001	< 0.001^a
Platelet (× 10⁹/L)	227.58 ± 67.77	215.50 (168.00-256.25)	213.72 ± 77.64	0.267	/	/
CRP_i (mg/L)	2.70 (0-19.30)	8.55 (1.70-75.95)	9.95 (0.83-73.35)	< 0.001	< 0.001	1.000
CRP₄₈ (mg/L)	34.10 (4.60-91.40)	119.50 ± 70.00	166.33 ± 88.67	< 0.001	< 0.001	0.125
HCT (%)	42.77 ± 5.05	43.29 ± 5.47	43.42 ± 6.27	0.562	/	/
RDW	13.20 (12.80-13.80)	13.50 (12.90-14.20)	13.85 (13.20-14.65)	< 0.001	0.178	0.102
GLU (mmol/L)	6.66 (5.40-8.72)	8.45 (6.42-12.04)	10.28 (7.48-14.33)	< 0.001	< 0.001	0.326
BUN (mmol/L)	4.53 (3.55-5.59)	4.86 (3.63-6.32)	5.32 (4.18-6.29)	0.019	0.211	1.000
Ca²⁺ (mmol/L)	2.23 ± 0.15	2.14 ± 0.16	1.96 ± 0.34	< 0.001	< 0.001	< 0.001^a
AST (IU/L)	25.00 (17.90-68.00)	34.65 (17.00-138.25)	41.00 (22.00-352.70)	0.067	/	/
Creatinine (mg/dL)	63.00 (52.20-78.00)	67.00 (55.75-87.00)	65.50 (54.25-84.25)	0.082	/	/
LDH	224.00 (189.00-277.00)	250.00 (198.50-426.75)	299.50 (228.25-414.25)	< 0.001	0.031	0.080
D dimer	195.00 (105.00-356.00)	358.50 (173.25-967.50)	467.00 (211.50-859.25)	< 0.001	< 0.001	0.782
Triglyceride	1.86 (1.05-8.44)	2.33 (1.06-17.50)	2.45 (1.21-20.99)	0.052	/	/
NLR	5.61 (3.40-9.89)	8.73 (5.21-14.20)	10.23 (6.71-16.49)	< 0.001	< 0.001	0.546
LMR	2.53 (1.60-3.69)	1.84 (1.01-3.22)	1.64 (0.98-3.01)	< 0.001	0.003	1.000
PLR	153.37 (113.33-230.19)	183.02 (115.48-262.88)	201.41 (131.94-297.87)	0.044	0.475	0.902
PNI_i	50.7 (46.45-54.55)	49.61 ± 8.65	48.83 (41.29-52.75)	0.035	0.299	1.000
PNI₄₈	43.37 ± 5.40	38.38 ± 5.68	34.43 ± 3.87	< 0.001	< 0.001	< 0.001^a
APACHE II	5.00 (3.00-6.00)	7.50 (5.00-10.00)	9.00 (6.75-13.25)	< 0.001	< 0.001	0.046^a
SOFA	0 (0-1.00)	1.00 (0-3.00)	2.00 (1.00-4.00)	< 0.001	< 0.001	0.011^a
BISAP	0 (0-1.00)	2.00 (1.00-2.00)	2.00 (2.00-3.00)	< 0.001	< 0.001	0.014^a
CTSI	2.00 (2.00-3.00)	4.00 (3.00-5.00)	6.00 (5.00-6.25)	< 0.001	< 0.001	0.004^a
Ranson	1.00 (0-2.00)	3.00 (2.00-4.00)	4.50 (3.00-6.00)	< 0.001	< 0.001	0.001^a

^aP < 0.05.

MAP: Mild acute pancreatitis; MSAP: Moderately severe acute pancreatitis; SAP: Severe acute pancreatitis; WCC: White cell count; CRPi: C-reactive protein measured at admission; CRP₄₈: C-reactive protein measured within 48 hours; RDW: Red cell distribution width; HCT: Hematocrit; GLU: Glucose; BUN: Blood urea nitrogen; AST: Aspartate aminotransferase; LDH: Lactate dehydrogenase; NLR: Neutrophil-lymphocyte ratio; LMR: Lymphocyte-monocyte ratio; PLR: Platelet-lymphocyte ratio; PNI_i: Prognostic nutritional index measured at admission; PNI₄₈: Prognostic nutritional index measured within 48 hours; APACHE II: Acute Physiology and Chronic Health Evaluation II; SOFA: Sequential organ failure assessment; BISAP: Bedside index of severity in acute pancreatitis; CTSI: Computed tomography severity index.

Table 3 Results of univariate and multivariate logistic regression analysis for predicting severe acute pancreatitis

Variables	Univariate analysis		Multivariate analysis
Variables	OR (95%CI)	P value	OR (95%CI)	P value
Age (> 50 years)	1.271 (0.707-2.288)	0.423
Gender	1.066 (0.569-1.999)	0.841
Etiology of AP	0.780 (0.622-0.979)	0.032^a	1.191 (0.850-1.668)	0.309
BMI (≥ 25 kg/m²)	1.180 (0.655-2.125)	0.617
Smoking	0.948 (0.724-1.243)	0.701
Comorbidities
Diabetes mellitus	2.059 (1.120-3.785)	0.020^a	1.814 (0.807-4.074)	0.149
Hypertension	0.758 (0.396-1.453)	0.404
Coronary artery disease	2.304 (0.821-6.469)	0.113
Chronic kidney disease	0.916 (0.114-7.386)	0.934
Biliary tract disease	0.837 (0.455-1.540)	0.567
Medical attention from symptom onset (hours)	0.995 (0.981-1.010)	0.506
WCC (× 10⁹/L)	1.095 (1.030-1.163)	0.003^a	1.071 (0.994-1.155)	0.072
Platelet (× 10⁹/L)	0.997 (0.993-1.002)	0.237
CRP_i (mg/L)	1.006 (1.002-1.010)	0.001^a	/	/
CRP₄₈ (mg/L)	1.013 (1.009-1.017)	< 0.001^a	1.006 (1.001-1.011)	0.010^a
HCT (%)	1.020 (0.964-1.079)	0.499
RDW	1.083 (1.002-1.170)	0.044^a	1.000 (0.857-1.167)	0.998
GLU (mmol/L)	1.003 (0.994-1.013)	0.521
BUN (mmol/L)	0.999 (0.982-1.017)	0.943
Ca (mmol/L)	0.004 (0.001-0.021)	< 0.001^a	0.091 (0.016-0.512)	0.007^a
AST (IU/L)	1.001 (1.000-1.002)	0.121
Creatinine (mg/dL)	1.000 (0.997-1.003)	0.993
LDH	1.003 (1.001-1.005)	< 0.001^a	1.001 (0.999-1.004)	0.282
D dimer	1.000 (1.000-1.001)	0.002^a	1.000 (1.000-1.000)	0.189
Triglyceride	1.030 (1.004-1.056)	0.022^a	1.032 (0.996-1.070)	0.086
NLR	1.036 (1.013-1.059)	0.002^a	0.992 (0.961-1.024)	0.625
LMR	1.026 (0.975-1.081)	0.321
PLR	1.001 (1.000-1.003)	0.065
PNI_i	1.003 (0.997-1.009)	0.277
PNI₄₈	0.765 (0.711-0.823)	< 0.001^a	0.822 (0.749-0.902)	< 0.001^a

^aP < 0.05.

OR: Odds ratio; CI: Confidence interval; AP: Acute pancreatitis; BMI: Body mass index; WCC: White cell count; CRPi: C-reactive protein measured at admission; CRP₄₈: C-reactive protein measured within 48 hours; HCT: Hematocrit; RDW: Red cell distribution width; GLU: Glucose; BUN: Blood urea nitrogen; AST: Aspartate aminotransferase; LDH: Lactate dehydrogenase; NLR: Neutrophil-lymphocyte ratio; LMR: Lymphocyte-monocyte ratio; PLR: Platelet-lymphocyte ratio; PNI_i: Prognostic nutritional index measured at admission; PNI₄₈: Prognostic nutritional index measured within 48 hours.

Table 4 Statistical data of receiver-operating characteristics curve analysis for predicting severe acute pancreatitis by different parameters

Variables	AUC (95%CI)	P value	Cut-off value	Sensitivity, %	Specificity, %	PPV, %	NPV, %
CRP₄₈	0.802 (0.734-0.870)	< 0.001	118.25	76.00	76.51	28.15	96.34
Ca²⁺	0.736 (0.643-0.828)	< 0.001	2.045	60.00	84.99	32.61	94.61
PNI₄₈	0.871 (0.826-0.916)	< 0.001	38.53	90.00	74.33	29.80	98.40
CRP₄₈ + Ca²⁺ + PNI₄₈	0.892 (0.843-0.940)	< 0.001	0.15	78.00	86.68	40.86	96.76
APACHE II	0.799 (0.735-0.864)	< 0.001	7.50	72.00	77.97	28.35	95.83
SOFA	0.783 (0.711-0.856)	< 0.001	1.50	72.00	74.09	25.17	95.63
BISAP	0.895 (0.862-0.929)	< 0.001	1.50	94.00	79.18	35.34	99.09
CTSI	0.931 (0.900-0.962)	< 0.001	4.50	80.00	89.83	48.78	97.38
Ranson	0.914 (0.878-0.949)	< 0.001	2.50	88.00	77.97	32.59	98.17
PNI₄₈ + Ranson	0.936 (0.909-0.962)	< 0.001	0.07	94.00	81.11	37.60	99.11

AUC: Area under the curve; CI: Confidence interval; PPV: Positive predictive value; NPV: Negative predictive value; CRP₄₈: C-reactive protein measured within 48 hours; PNI₄₈: Prognostic nutritional index measured within 48 hours; APACHE II: Acute Physiology and Chronic Health Evaluation II; SOFA: Sequential organ failure assessment; BISAP: Bedside index of severity in acute pancreatitis; CTSI: Computed tomography severity index.

Citation: Shi PN, Song ZZ, He XN, Hong JM. Evaluation of scoring systems and hematological parameters in the severity stratification of early-phase acute pancreatitis. World J Gastroenterol 2025; 31(15): 105236
URL: https://www.wjgnet.com/1007-9327/full/v31/i15/105236.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i15.105236