Clinical study of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in hypertriglyceridemia-induced acute pancreatitis and acute biliary pancreatitis with persistent organ failure

doi:10.4240/wjgs.v16.i6.1647

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Jun 27, 2024 (publication date) through Jun 29, 2024

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Jun 27, 2024; 16(6): 1647-1659
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1647

Table 1 Baseline characteristics

Characteristics		Overall (771)	HTGP (241)	ABP (530)	P value
Age (yr)		49 (37.0; 63.0)	37 (26.0; 53.8)	56 (30.0; 84.0)	< 0.001
Sex, n (%)					< 0.001
	Male	466 (60.4)	184 (76.3)	282 (53.2)
	Female	305 (39.6)	57 (23.7)	248 (46.8)
BMI (kg/m²)		26 (23.4; 28.7)	27.8 (22.0; 35.3)	25.4 (19.0; 33.7)	< 0.001
Smoking, n (%)					< 0.001
	N	515 (66.8)	131 (54.4)	384 (72.5)
	Y	256 (33.2)	110 (45.6)	146 (27.5)
Drinking, n (%)					< 0.001
	N	550 (71.3)	147 (61)	403 (76)
	Y	221 (28.7)	94 (39)	127 (24)
Diabetes, n (%)					< 0.001
	N	643 (83.4)	173 (71.8)	470 (88.7)
	Y	128 (16.6)	68 (28.2)	60 (11.3)
Hypertension, n (%)					< 0.001
	N	581 (75.4)	202 (83.8)	379 (71.5)
	Y	190 (24.6)	39 (16.2)	151 (28.5)
Hyperlipidemia, n (%)					< 0.001
	N	583 (75.6)	88 (36.5)	495 (93.4)
	Y	188 (24.4)	153 (63.5)	35 (6.6)
Laboratory data
	ALT	63.6 (26.0; 181.3)	31.9 (9.7; 111.7)	108.8 (13; 616.8)	< 0.001
	AST	46.2 (24.4; 130.2)	28.8 (13.0; 114.1)	70.1 (16.1; 638.0)	< 0.001
	ALP	108.9 (79.1; 108.9)	101.1 (41.9; 118.1)	108.9 (55.3; 258.5)	< 0.001
	γ-GT	219.5 (119.7; 219.5)	219.5 (17.6; 318.2)	219.5 (31.0; 696.6)	< 0.001
	ALB	36.4 (31.8; 41.4)	37.0 (21.6; 48.6)	36.3 (18.3; 48.3)	0.018
	TBIL	23.7 (14.4; 36.7)	19.9 (3.0; 44.4)	27.1 (5.1; 106.1)	< 0.001
	DBIL	8.8 (3.8; 13.4)	4.0 (0.6; 15.1)	11.2 (2.5; 67.2)	< 0.001
	TC	4.8 (3.4; 5.4)	6.8 (3.3; 17.7)	4.0 (1.0; 5.5)	< 0.001
	TG	1.9 (0.9; 3.9)	7.4 (1.0; 38.8)	1.1 (0.3; 3.9)	< 0.001
	SCr	75.9 (62.9; 86.9)	79.0 (43.4; 157.4)	75.0 (48.4; 127.3)	0.174
	AMY	256.0 (82.6; 729.5)	191.6 (30.0; 927.5)	343.1 (38.4; 2053.5)	< 0.001
	LPS	344.3 (97.7; 878.8)	323.2 (47.5; 1312.0)	391.9 (28.4; 1709.6)	0.15
	PT-S	12.8 (11.9; 13.3)	12.2 (10.7; 14.4)	12.9 (11.1; 16.0)	< 0.001
	FIB	4.4 (3.3; 5.2)	5.2 (2.6; 9.0)	4.1 (2.4; 6.9)	< 0.001
	WBC	11.1 (7.7; 14.5)	11.8 (5.8; 21.0)	10.6 (4.6; 20.2)	< 0.001
	Lym	1.1 (0.7; 1.5)	1.3 (0.7; 3.1)	1.0 (0.4; 2.1)	< 0.001
	RBC	4.6 (4.1; 5.1)	5.0 (4.0; 6.1)	4.4 (3.4; 5.7)	< 0.001
	RDW	13.3 (12.5; 14.1)	13.2 (9.8; 14.4)	13.5 (9.9; 16.2)	0.003
	PLT	203.0 (164.0; 254.0)	223.0 (134.1; 391.0)	197.0 (103.6; 339.4)	< 0.001
	PDW	16.8 (16.3; 17.4)	17.3 (12.8; 19.1)	16.6 (11.8; 18.1)	< 0.001
NLR		8.3 (4.5; 14.2)	6.9 (1.6; 18.9)	9.1 (2.1; 33.1)	< 0.001
PLR		184.3 (131.6; 273.6)	160.5 (70.3; 379.0)	203.1 (83.4; 518.6)	< 0.001
Atlanta classification, n (%)					0.001
	MAP	437 (56.7)	125 (51.9)	312 (58.9)
	MSAP	156 (20.2)	40 (16.6)	116 (21.9)
	SAP	178 (23.1)	76 (31.5)	102 (19.2)
Scoring systems
	MCTSI	4.0 (2.0; 6.0)	4.0 (2.0; 8.0)	4.0 (2.0; 8.0)	0.005
	JSS	1.0 (0; 2.0)	1.0 (0; 4.0)	1.0 (0; 4.0)	0.029
	BISAP	1.0 (0; 1.0)	0 (0; 2.0)	1.0 (0; 2.0)	< 0.001
	Modified Marshall	2.0 (1.0; 4.0)	2.0(0; 5.9)	2.0 (0; 7.0)	0.049
	SOFA	1.0 (0; 3.0)	1.0 (0; 4.0)	1.0 (0; 5.0)	0.163
POF, n (%)					0.247
	N	537 (69.6)	161 (66.8)	376 (70.9)
	Y	234 (30.4)	80 (33.2)	154 (29.1)
SIRS, n (%)					0.956
	N	465 (60.3)	145 (60.2)	320 (60.4)
	Y	306 (39.7)	96 (39.8)	210 (39.6)
Hospital stay (d)		13.5 (9.4; 19.2)	12.0 (5.2; 29.3)	14.3 (5.4; 36.1)	< 0.001
Mortality, n (%)					0.556
	N	762 (98.8)	239 (99.2)	523 (98.7)
	Y	9 (1.2)	2 (0.8)	7 (1.3)

N: No; Y: Yes; BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; γ-GT: Gamma-glutamyl transferase; ALB: Albumin; TBIL: Total bilirubin; DBIL: Direct bilirubin; TC: Total cholesterol; TG: Triglycerides; SCr: Serum creatinine; AMY: Serum amylase; LPS: Lipase; PT-S: Prothrombin time; FIB: Fibrinogen; WBC: White blood cell; Lym: Lymphocyte; RBC: Red blood cell; RDW: Red blood cell distribution width; PLT: Platelet; PDW: Platelet distribution width; MCTSI: Modified computed tomography severity index score; JSS: Japanese Severity Score; BISAP: Bedside Index of Severity in Acute Pancreatitis; Modified Marshall: Modified Organ Dysfunction Score; SOFA: Sequential Organ Failure Assessment Score; SIRS: Systemic Inflammatory Response Syndrome; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; HTGP: Hypertriglyceridemia-induced acute pancreatitis; ABP: Acute biliary pancreatitis.

Table 2 Correlation analysis of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio with the acute pancreatitis Scoring System in hypertriglyceridemia-induced acute pancreatitis

Parameters	PLR	P value	NLR	P value
Atlanta classification		0.000		0.005
Mild/moderate	152.1 (110.8; 198.0)		6.3 (3.5; 10.2)
Severe	188.2 (137.9; 265.6)		7.9 (5.5; 12.6)
MCTSI		0.087		0.235
< 4	150.6 (113.4; 197.4)		6.1 (3.4; 10.1)
≥ 4	161.7 (119.1; 240.6)		7.0 (4.4; 11.2)
JSS		0.754		0.815
< 3	159.0 (119.9; 228.0)		6.9 (3.9; 11.2)
≥ 3	161.2 (108.2; 257.6)		7.0 (5.0; 10.2)
BISAP		0.384		0.395
< 3	159.1 (119.0; 228.4)		6.9 (4.0; 10.9)
≥ 3	171.6 (136.7; 244.4)		9.1 (5.8; 12.9)
Modified Marshall		0.167		0.813
< 2	156.2 (113.4; 214.1)		6.8 (3.8; 11.6)
≥ 2	165.1 (132.0; 239.1)		7.0 (4.9; 10.3)
SOFA		0.011		0.005
< 3	155.6 (113.2; 214.9)		6.4 (3.6; 10.1)
≥ 3	175.0 (136.0; 259.6)		8.0 (5.9; 12.8)

MCTSI: Modified computed tomography severity index score; JSS: Japanese Severity Score; BISAP: Bedside Index of Severity in Acute Pancreatitis; Modified Marshall: Modified Organ Dysfunction Score; SOFA: Sequential Organ Failure Assessment Score; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio.

Table 3 Correlation Analysis of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio with the acute pancreatitis Scoring System in acute biliary pancreatitis

Parameters	PLR	P value	NLR	P value
Atlanta classification		0.002		0.000
Mild/moderate	194.0 (136.2; 286.2)		8.1 (4.3; 13.8)
Severe	239.1 (171.0; 358.9)		16.0 (8.9; 21.8)
MCTSI		0.021		0.000
< 4	190.8 (135.4; 268.6)		7.4 (4.0; 12.8)
≥ 4	212.7 (145.3; 322.9)		11.2 (6.0; 17.6)
JSS		0.006		0.000
< 3	194.5 (139.2; 287.6)		8.2 (4.3; 14.2)
≥ 3	250.6 (150.7; 359.1)		16.5 (8.7; 22.9)
BISAP		0.921		0.002
< 3	203.8 (141.9; 295.9)		8.9 (4.5; 15.7)
≥ 3	192.9 (130.4; 329.9)		15.6 (11.2; 20.4)
Modified Marshall		0.015		0.000
< 2	181.2 (134.0; 272.3)		6.0 (3.5; 12.0)
≥ 2	217.2 (145.2; 314.6)		11.3 (6.2; 18.3)
SOFA		0.555		0.000
< 3	198.5 (140.4; 296.4)		8.2 (4.1; 14.5)
≥ 3	212.2 (142.1; 311.3)		12.4 (7.3; 19.3)

Table 4 Predictive performance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the acute pancreatitis Scoring System for the occurrence of persistent organ failure in hypertriglyceridemia-induced acute pancreatitis

Parameters	AUC	95%CI		Sensitivity	Specificity	P value
Parameters	AUC	Lower	Upper	Sensitivity	Specificity	P value
MCTSI	0.718	0.649	0.786	0.650	0.733	< 0.001
JSS	0.703	0.631	0.775	0.663	0.720	< 0.001
BISAP	0.705	0.634	0.775	0.725	0.652	< 0.001
Modified Marshall	0.772	0.708	0.835	0.663	0.795	< 0.001
SOFA	0.827	0.772	0.882	0.713	0.820	< 0.001
PLR	0.622	0.546	0.699	0.413	0.826	0.002
NLR	0.619	0.546	0.693	0.800	0.720	0.003

CI: Confidence interval; AUC: Area under the curve; MCTSI: Modified computed tomography severity index score; JSS: Japanese Severity Score; BISAP: Bedside Index of Severity in Acute Pancreatitis; Modified Marshall: Modified Organ Dysfunction Score; SOFA: Sequential Organ Failure Assessment Score; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio.

Table 5 Predictive performance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the acute pancreatitis Scoring System for the occurrence of persistent organ failure in acute biliary pancreatitis

Parameters	AUC	95%CI		Sensitivity	Specificity	P value
Parameters	AUC	Lower	Upper	Sensitivity	Specificity	P value
MCTSI	0.573	0.517	0.629	0.409	0.729	0.008
JSS	0.760	0.715	0.805	0.591	0.782	< 0.001
BISAP	0.694	0.645	0.743	0.448	0.827	< 0.001
Modified Marshall	0.761	0.717	0.804	0.675	0.705	< 0.001
SOFA	0.746	0.703	0.789	0.942	0.465	< 0.001
PLR	0.569	0.516	0.621	0.727	0.418	0.013
NLR	0.668	0.618	0.717	0.532	0.761	< 0.001

Citation: Xu MS, Xu JL, Gao X, Mo SJ, Xing JY, Liu JH, Tian YZ, Fu XF. Clinical study of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in hypertriglyceridemia-induced acute pancreatitis and acute biliary pancreatitis with persistent organ failure. World J Gastrointest Surg 2024; 16(6): 1647-1659
URL: https://www.wjgnet.com/1948-9366/full/v16/i6/1647.htm
DOI: https://dx.doi.org/10.4240/wjgs.v16.i6.1647