Predictive value of red cell distribution width-albumin ratio combined with C-reactive protein/lymphocyte ratio and bedside index for severity in acute pancreatitis in the severity of moderate-to-severe acute pancreatitis

doi:10.3969/j.issn.1004-583X.2025.07.003

Abstract

Abstract:

Objective To investigate the predictive value of red cell distribution width-albumin ratio (RAR) combined with C-reactive protein/lymphocyte ratio (CLR) and bedside index for severity in acute pancreatitis (BISAP) score in the early assessment of the severity of acute pancreatitis (AP). Methods A total of 237 AP patients admitted to the First People's Hospital of Jining from April 2022 to October 2024 were selected. They were divided into the severe acute pancreatitis (SAP) group (n=110) and non-SAP group (n=127) according to the revised Atlanta classification criteria for AP. The general data and related laboratory indicators of the two groups were collected and compared. Results White blood cell count, C-reactive protein, CLR, serum amylase, lactate dehydrogenase, procalcitonin and BISAP scores in the SAP group were significantly higher, while albumin, lymphocyte ratio, serum calcium ion and RAR were significantly lower than those in the non-SAP group (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of RAR combined with CLR and BISAP score was significantly larger than the single indicator or RAR combined with CLR (P<0.005), with a sensitivity of 86.4% and a specificity of 79.5%. Conclusion BISAP score, RAR, CLR, RAR combined with CLR, and RAR combined with CLR and BISAP score are all valid indicators for assessing the severity of AP. In contrast, the predictive value of RAR combined with CLR and BISAP score is better and more accurate, which is applicable to the comprehensive assessment of AP, and can be promoted and widely used in clinical practice.

Key words: acute pancreatitis, erythrocyte distribution width, albumin, C-reactive protein, lymphocyte ratio, BISAP score, predictive value

CLC Number:

R576

Zhang Jingzhi, Zhang Yanli, Meng Qingshun. Predictive value of red cell distribution width-albumin ratio combined with C-reactive protein/lymphocyte ratio and bedside index for severity in acute pancreatitis in the severity of moderate-to-severe acute pancreatitis[J]. Clinical Focus, 2025, 40(7): 595-601.

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References 54

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项目	非SAP(n=127)	SAP组(n=110)	t/χ²值	P值
年龄(岁)	45.43±13.45	49.96±17.92	-2.173	0.031
性别[例(%)]
男女	98(77.2) 29(22.8)	75(68.2) 35(31.8)	2.413	0.120
病因[例(%)]
高脂血症	62(48.8)	47(42.7)
胆源性	19(15.0)	18(16.4)	0.887	0.642
其他	46(36.2)	45(40.9)
高血压史[例(%)]	31(24.4)	26(23.6)	0.019	0.890
糖尿病史[例(%)]	27(21.3)	24(21.8)	0.011	0.917
吸烟史[例(%)]	45(35.4)	30(27.3)	1.815	0.178
饮酒史[例(%)]	47(37.0)	35(31.8)	0.702	0.402
住院时间(d)	6.69±2.45	11.19±5.90	-7.455	0.000

项目	非SAP(n=127)	SAP组(n=110)	t/χ²值	P值
年龄(岁)	45.43±13.45	49.96±17.92	-2.173	0.031
性别[例(%)]
男女	98(77.2) 29(22.8)	75(68.2) 35(31.8)	2.413	0.120
病因[例(%)]
高脂血症	62(48.8)	47(42.7)
胆源性	19(15.0)	18(16.4)	0.887	0.642
其他	46(36.2)	45(40.9)
高血压史[例(%)]	31(24.4)	26(23.6)	0.019	0.890
糖尿病史[例(%)]	27(21.3)	24(21.8)	0.011	0.917
吸烟史[例(%)]	45(35.4)	30(27.3)	1.815	0.178
饮酒史[例(%)]	47(37.0)	35(31.8)	0.702	0.402
住院时间(d)	6.69±2.45	11.19±5.90	-7.455	0.000

项目	非SAP组(n=127)	SAP组(n=110)	t/Z值	P值
WBC(×10⁹/L)	12.00±3.69	13.09±4.34	-2.11	0.036
HGB(g/L)	153.39±18.91	155.28±24.97	-0.65	0.518
PLT(×10⁹/L)	250.33±64.37	245.69±81.50	0.49	0.625
CRP(mg/L)	19.03(5.65,58.01)	50.12(18.53,98.32)	-4.48	0.000
LY%	12.90(9.50,18.00)	9.75(5.98,15.30)	-3.33	0.001
CLR	0.93(0.39,2.31)	5.11(1.21,12.76)	-6.43	0.000
RDW(%)	12.20(11.90,12.70)	12.35(11.90,12.90)	-1.40	0.160
ALB(g/L)	39.95±4.21	38.05±5.75	2.86	0.005
RAR	2.11(0.32,9.90)	0.32(0.29,0.38)	-6.81	0.000
AMY(IU/L)	265.50(115.40,519.00)	460.95(137.00,1118.00)	-2.87	0.004
Scr(μmol/L)	60.70(49.90,72.00)	58.65(48.65,72.38)	-0.17	0.866
BUN(mg/L)	4.29(3.32,5.30)	4.20(3.34,5.70)	-0.39	0.700
LDH(IU/L)	216.00(180.00,282.00)	259.00(207.68,345.25)	-3.76	0.000
Ca²⁺(mmol/L)	2.18±0.13	2.09±0.21	3.56	0.000
PCT(μg/L)	0.06(0.04,0.13)	0.13(0.07,0.58)	-4.47	0.000
BISAP评分(分)	1(0,1)	2(1,2)	-7.80	0.000

项目	非SAP组(n=127)	SAP组(n=110)	t/Z值	P值
WBC(×10⁹/L)	12.00±3.69	13.09±4.34	-2.11	0.036
HGB(g/L)	153.39±18.91	155.28±24.97	-0.65	0.518
PLT(×10⁹/L)	250.33±64.37	245.69±81.50	0.49	0.625
CRP(mg/L)	19.03(5.65,58.01)	50.12(18.53,98.32)	-4.48	0.000
LY%	12.90(9.50,18.00)	9.75(5.98,15.30)	-3.33	0.001
CLR	0.93(0.39,2.31)	5.11(1.21,12.76)	-6.43	0.000
RDW(%)	12.20(11.90,12.70)	12.35(11.90,12.90)	-1.40	0.160
ALB(g/L)	39.95±4.21	38.05±5.75	2.86	0.005
RAR	2.11(0.32,9.90)	0.32(0.29,0.38)	-6.81	0.000
AMY(IU/L)	265.50(115.40,519.00)	460.95(137.00,1118.00)	-2.87	0.004
Scr(μmol/L)	60.70(49.90,72.00)	58.65(48.65,72.38)	-0.17	0.866
BUN(mg/L)	4.29(3.32,5.30)	4.20(3.34,5.70)	-0.39	0.700
LDH(IU/L)	216.00(180.00,282.00)	259.00(207.68,345.25)	-3.76	0.000
Ca²⁺(mmol/L)	2.18±0.13	2.09±0.21	3.56	0.000
PCT(μg/L)	0.06(0.04,0.13)	0.13(0.07,0.58)	-4.47	0.000
BISAP评分(分)	1(0,1)	2(1,2)	-7.80	0.000

变量	回归系数	标准误	Waldχ²值	P值	OR值	95%CI
CRP	0.011	0.003	16.318	0.000	1.011	1.006~1.017
Ca²⁺	-2.867	0.834	11.811	0.001	0.057	0.011~0.292
PCT	0.231	0.103	5.038	0.025	1.260	1.030~1.542
AMY	0.000	0.000	5.143	0.023	1.000	1.000~1.001
LDH	0.002	0.001	5.526	0.019	1.002	1.000~1.004
BISAP评分	1.366	0.200	46.550	0.000	3.921	2.648~5.805
CLR	0.157	0.030	27.377	0.000	1.170	1.103~1.241
RAR	-0.979	0.239	16.829	0.000	0.376	0.235~0.600
ALB	-0.077	0.027	7.940	0.005	0.926	0.877~0.977
LY%	-0.041	0.018	5.325	0.021	0.960	0.927~0.094