Clinical value of procalcitonin combined with inflammatory markers in early prediction of severe acute pancreatitis
降钙素原联合炎症指标在早期预测重症急性胰腺炎中的临床价值研究

摘要

目的 探讨入院时血清降钙素原（PCT）联合C反应蛋白（CRP）及中性粒细胞-淋巴细胞比值（NLR）在早期预测急性胰腺炎（AP）重症化风险中的临床价值。方法 采用前瞻性观察性研究方法，连续纳入2022年6月至2024年6月我院收治的发病48小时内的AP患者180例。根据修订版亚特兰大标准分为重症组（SAP组，n=40）和非重症组（非SAP组，n=140）。检测所有患者入院时的PCT、CRP及NLR。采用单因素分析比较两组差异，通过多因素Logistic回归分析筛选SAP的独立预测因素，并构建联合预测模型。绘制受试者工作特征曲线评估各指标及联合模型的预测效能。结果 SAP组入院时PCT、CRP、NLR、APACHE II评分均显著高于非SAP组。多因素分析显示，入院PCT>1.5 ng/mL、CRP>100 mg/L、NLR>8是SAP发生的独立危险因素。基于此构建的联合预测模型预测SAP的曲线下面积（AUC）为0.936（95% CI：0.897-0.975），显著优于任一单一指标：PCT（AUC=0.865）、CRP（AUC=0.782）、NLR（AUC=0.721）。联合模型（CPI）的敏感性和特异性分别为90.0%和88.6%。结论 入院时血清PCT、CRP及NLR是预测SAP早期有效指标。CPI具有更高的预测效能，能更精准地早期识别高风险患者，为临床实施早期强化干预提供可靠的决策依据。

Abstract

Objective To explore the clinical value of serum procalcitonin (PCT) combined with C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) in early prediction of the risk of acute pancreatitis (AP).
Methods 180 patients with AP admitted to our hospital within 48 hours from June 2022 to June 2024 were included in the prospective observational study. According to the revised Atlanta standard, they were divided into severe group (SAP group, n=40) and non-severe group (non-SAP group, n=140). PCT, CRP and NLR were detected in all patients at admission. The differences between the two groups were compared by single factor analysis, and the independent predictors of SAP were screened by multivariate Logistic regression analysis, and a joint prediction model was constructed.
Results The scores of PCT, CRP, NLR and APACHEII in SAP group were significantly higher than those in non-SAP group. Multivariate analysis showed that PCT>1.5ng/mL, CRP>100mg/L and NLR>8 were independent risk factors for SAP. The area under the curve (AUC) of SAP is 0.936 (95% CI: 0.897-0.975), which is significantly better than any single index: PCT(AUC=0.865), CRP(AUC=0.782) and NLR(AUC=0.721). The sensitivity and specificity of combined model (CPI) were 90.0% and 88.6% respectively.
Conclusion   Serum PCT, CRP and NLR at admission are effective indicators to predict the early stage of SAP. CPI has higher prediction efficiency, can identify high-risk patients more accurately in the early stage, and provide reliable decision-making basis for clinical implementation of early intensive intervention.