RAR、CLR联合BISAP评分对中重度急性胰腺炎病情严重程度的预测价值

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

摘要/Abstract

摘要：

目的探讨红细胞分布宽度与血清白蛋白比值(red cell distribution width-albumin ratio,RAR)、C反应蛋白/淋巴细胞比率比值(C-reactive protein/lymphocyte ratio,CLR)联合急性胰腺炎严重程度床边指数(bedside index for severity in acute pancreatitis,BISAP)评分对急性胰腺炎(acute pancreatitis, AP)患者病情严重程度进行早期评估的预测价值。方法选取2022年4月-2024年10月济宁市第一人民医院收治的AP患者237例,根据修订的亚特兰大急性胰腺炎分级标准分为重度急性胰腺炎(severe acute pancreatitis,SAP)组(n=110)和非SAP组(n=127)。收集并比较两组的一般资料及相关实验室指标。结果 SAP组白细胞计数、C反应蛋白、CLR、血清淀粉酶、乳酸脱氢酶、降钙素原及BISAP评分均高于非SAP组,白蛋白、淋巴细胞比率、血清钙离子、RAR均低于非SAP组,差异均有统计学意义(P<0.05)。受试者工作特征曲线分析显示,RAR、CLR联合BISAP评分的曲线下面积高于BISAP评分、RAR、CLR及RAR联合CLR(P<0.005),其敏感度为86.4%,特异度为79.5%。结论 BISAP评分、RAR、CLR、RAR联合CLR及RAR、CLR联合BISAP评分均为评估AP病情严重程度的有效指标,相比之下,RAR、CLR联合BISAP评分的预测价值较好,更加准确,适用于对AP的综合评估,可广泛用于临床实践,值得推广。

关键词: 急性胰腺炎, 红细胞分布宽度, 白蛋白, C反应蛋白, 淋巴细胞比率, BISAP评分, 预测价值

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

中图分类号:

R576

张敬知, 张艳丽, 孟庆顺. RAR、CLR联合BISAP评分对中重度急性胰腺炎病情严重程度的预测价值[J]. 临床荟萃, 2025, 40(7): 595-601.

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.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.07.003

https://www.lchc.cn/CN/Y2025/V40/I7/595

图/表 7

参考文献 54

[1]	Garg PK, Madan K, Pande GK, et al. Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis[J]. Clin Gastroenterol Hepatol, 2005, 3:159-166.
[2]	Warndorf MG, Kurtzman JT, Bartel MJ, et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis[J]. Clin Gastroenterol Hepatol, 2011, 9(8):705-709.
[3]	Dalkılınç Hökenek U, Kılıç M, Alışkan H. Investigation of the prognostic role of systemic immunoinflammatory index in patients with acute pancreatitis[J]. Ulus Travma Acil Cerrahi Derg, 2023, 29(3):316-320. doi: 10.14744/tjtes.2023.96554 pmid: 36880632
[4]	Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: A review[J]. JAMA, 2021, 325(23):2405.
[5]	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: Revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1):102-111. doi: 10.1136/gutjnl-2012-302779 pmid: 23100216
[6]	Capurso G, Ponz de Leon Pisani R, Lauri G, et al. Clinical usefulness of scoring systems to predict severe acute pancreatitis: A systematic review and meta-analysis with pre and post-test probability assessment[J]. United European Gastroenterol J, 2023, 11(9):825-836.
[7]	Ko CA, Fang KH, Hsu CM, et al. The preoperative C-reactive protein-lymphocyte ratio and the prognosis of oral cavity squamous cell carcinoma[J]. Head Neck, 2021, 43(9):2740-2754.
[8]	Buter A, Imrie CW, Carter CR, et al. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis[J]. Br J Surg, 2002, 89(3):298-302.
[9]	Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis[J]. Gut, 2004, 53(9):1340-1344. doi: 10.1136/gut.2004.039883 pmid: 15306596
[10]	Muckart DJ, Bhagwanjee S. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients[J]. Crit Care Med, 1997, 25(11):1789-1795. doi: 10.1097/00003246-199711000-00014 pmid: 9366759
[11]	Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis[J]. World J Emerg Surg, 2019, 14:27. doi: 10.1186/s13017-019-0247-0 pmid: 31210778
[12]	Silva-Vaz P, Abrantes AM, Castelo-Branco M, et al. Murine models of acute pancreatitis: A critical appraisal of clinical relevance[J]. Int J Mol Sci, 2019, 20(11):2794.
[13]	Ranson JH, Rifkind KM, Roses DF, et al. Objective early identification of severe acute pancreatitis[J]. Am J Gastroenterol, 1974, 61(6):443-451. pmid: 4835417
[14]	Ranson JH, Pasternack BS. Statistical methods for quantifying the severity of clinical acute pancreatitis[J]. J Surg Res, 1977, 22(2):79-91. doi: 10.1016/0022-4804(77)90045-2 pmid: 839764
[15]	Ranson JH. The timing of biliary surgery in acute pancreatitis[J]. Ann Surg, 1979, 189(5):654-663. pmid: 443917
[16]	Blamey SL, Imrie CW, O'Neill J, et al. Prognostic factors in acute pancreatitis[J]. Gut, 1984, 25(12):1340-1346. doi: 10.1136/gut.25.12.1340 pmid: 6510766
[17]	Imrie CW, Benjamin IS, Ferguson JC, et al. A single-centre double-blind trial of Trasylol therapy in primary acute pancreatitis[J]. Br J Surg, 1978, 65(5):337-341.
[18]	Knaus WA, Draper EA, Wagner DP, et al. APACHE II: A severity of disease classification system[J]. Crit Care Med, 1985, 13(10):818-829. pmid: 3928249
[19]	Harshit Kumar A, Singh Griwan M. A comparison of APACHE II, BISAP, Ranson's score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification[J]. Gastroenterol Rep (Oxf), 2018, 6(2):127-131.
[20]	Wu BU, Johannes RS, Sun X, et al. The early prediction of mortality in acute pancreatitis: A large population-based study[J]. Gut, 2008, 57(12):1698-1703. doi: 10.1136/gut.2008.152702 pmid: 18519429
[21]	Chandra S, Murali A, Bansal R, et al. The bedside index for severity in acute pancreatitis: A systematic review of prospective studies to determine predictive performance[J]. J Community Hosp Intern Med Perspect, 2017, 7(4):208-213.
[22]	Park JY, Jeon TJ, Ha TH, et al. Bedside index for severity in acute pancreatitis: Comparison with other scoring systems in predicting severity and organ failure[J]. Hepatobiliary Pancreat Dis Int, 2013, 12(6):645-650.
[23]	Singh VK, Wu BU, Bollen TL, et al. A prospective evaluation of the bedside index for severity in acute pancreatitis score in assessing mortality and intermediate markers of severity in acute pancreatitis[J]. Am J Gastroenterol, 2009, 104(4):966-971. doi: 10.1038/ajg.2009.28 pmid: 19293787
[24]	Vasudevan S, Goswami P, Sonika U, et al. Comparison of various scoring systems and biochemical markers in predicting the outcome in acute pancreatitis[J]. Pancreas, 2018, 47(1):65-71.
[25]	Hagjer S, Kumar N. Evaluation of the BISAP scoring system in prognostication of acute pancreatitis-A prospective observational study[J]. Int J Surg, 2018, 54(Pt A):76-81.
[26]	Balthazar EJ, Ranson JH, Naidich DP, et al. Acute pancreatitis: Prognostic value of CT[J]. Radiology, 1985, 156(3):767-772. pmid: 4023241
[27]	Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: Value of CT in establishing prognosis[J]. Radiology, 1990, 174(2):331-336. doi: 10.1148/radiology.174.2.2296641 pmid: 2296641
[28]	Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis[J]. Pancreatology, 2013, 13(4Suppl 2):e1-e15.
[29]	Raghuwanshi S, Gupta R, Vyas MM, et al. CT evaluation of acute pancreatitis and its prognostic correlation with CT severity index[J]. J Clin Diagn Res, 2016, 10(6):TC06-TC11.
[30]	Cheng T, Han TY, Liu BF, et al. Use of modified balthazar grades for the early prediction of acute pancreatitis severity in the emergency department[J]. Int J Gen Med, 2022, 15:1111-1119. doi: 10.2147/IJGM.S350383 pmid: 35153503
[31]	Sangoi MB, Da Silva SH, da Silva JE, et al. Relation between red blood cell distribution width and mortality after acute myocardial infarction[J]. Int J Cardiol, 2011, 146(2):278-280. doi: 10.1016/j.ijcard.2010.10.084 pmid: 21095023
[32]	Ani C, Ovbiagele B. Elevated red blood cell distribution width predicts mortality in persons with known stroke[J]. J Neurol Sci, 2009, 277(1-2):103-108. doi: 10.1016/j.jns.2008.10.024 pmid: 19028393
[33]	Hampole CV, Mehrotra AK, Thenappan T, et al. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension[J]. Am J Cardiol, 2009, 104(6):868-872. doi: 10.1016/j.amjcard.2009.05.016 pmid: 19733726
[34]	Oh HJ, Park JT, Kim JK, et al. Red blood cell distribution width is an independent predictor of mortality in acute kidney injury patients treated with continuous renal replacement therapy[J]. Nephrol Dial Transplant, 2012, 27(2):589-594.
[35]	Wang AY, Ma HP, Kao WF, et al. Red blood cell distribution width is associated with mortality in elderly patients with sepsis[J]. Am J Emerg Med, 2018, 36(6):949-953.
[36]	Miyamoto K, Inai K, Takeuchi D, et al. Relationships among red cell distribution width, anemia, and interleukin-6 in adult congenital heart disease[J]. Circ J, 2015, 79(5):1100-1106. doi: 10.1253/circj.CJ-14-1296 pmid: 25740502
[37]	Goyal H, Awad H, Hu ZD. Prognostic value of admission red blood cell distribution width in acute pancreatitis: A systematic review[J]. Ann Transl Med, 2017, 5(17):342. doi: 10.21037/atm.2017.06.61 pmid: 28936436
[38]	Wang X, Zhu L, Tao K, et al. Red cell distribution width to serum albumin ratio as an early prognostic marker for severe acute pancreatitis: A retrospective study[J]. Arab J Gastroenterol, 2022, 23(3):206-209. doi: 10.1016/j.ajg.2022.06.001 pmid: 35918288
[39]	Stirling AD, Moran NR, Kelly ME, et al. The predictive value of C-reactive protein (CRP) in acute pancreatitis-is interval change in CRP an additional indicator of severity?[J]. HPB (Oxford), 2017, 19(10):874-880.
[40]	Kokulu K, Günaydın YK, Akıllı NB, et al. Relationship between the neutrophil-to-lymphocyte ratio in acute pancreatitis and the severity and systemic complications of the disease[J]. Turk J Gastroenterol, 2018, 29(6):684-691. doi: 10.5152/tjg.2018.17563 pmid: 30381275
[41]	Liu Q, Zheng HL, Wu MM, et al. Association between lactate-to-albumin ratio and 28-days all-cause mortality in patients with acute pancreatitis: A retrospective analysis of the MIMIC-IV database[J]. Front Immunol, 2022, 13:1076121.
[42]	O'Connell RM, Boland MR, O'Driscoll J, et al. Red cell distribution width and neutrophil to lymphocyte ratio as predictors of outcomes in acute pancreatitis: A retrospective cohort study[J]. Int J Surg, 2018, 55:124-127. doi: S1743-9191(18)30777-5 pmid: 29807170
[43]	Chen X, Lin Z, Chen Y, et al. C-reactive protein/lymphocyte ratio as a prognostic biomarker in acute pancreatitis: A cross-sectional study assessing disease severity[J]. Int J Surg, 2024, 110(6):3223-3229. doi: 10.1097/JS9.0000000000001273 pmid: 38446844
[44]	Meng Y, Long C, Huang X, et al. Prognostic role and clinical significance of C-reactive protein-lymphocyte ratio in colorectal cancer[J]. Bioengineered, 2021, 12(1):5138-5148. doi: 10.1080/21655979.2021.1960768 pmid: 34436973
[45]	Lapi'c I, Padoan A, Bozzato D, et al. Erythrocyte sedimentation rate and C-reactive protein in acute inflammation[J]. Am J Clin Pathol, 2020, 153(1):14-29. doi: 10.1093/ajcp/aqz142 pmid: 31598629
[46]	Boras E, Slevin M, Alexander MY, et al. Monomeric C-reactive protein and Notch-3 co-operatively increase angiogenesis through PI3K signalling pathway[J]. Cytokine, 2014, 69(2):165-179. doi: 10.1016/j.cyto.2014.05.027 pmid: 24972386
[47]	van den Berg FF, de Bruijn AC, van Santvoort HC, et al. Early laboratory biomarkers for severity in acute pancreatitis; A systematic review and meta-analysis[J]. Pancreatology, 2020, 20(7):1302-1311. doi: 10.1016/j.pan.2020.09.007 pmid: 32938552
[48]	Gao N, Yan C, Zhang G. Changes of Serum Procalcitonin (PCT), C-Reactive Protein (CRP), Interleukin-17 (IL-17), Interleukin-6 (IL-6), High Mobility Group Protein-B1 (HMGB1) and D-Dimer in Patients with Severe Acute Pancreatitis Treated with Continuous Renal Replacement Therapy (CRRT) and Its Clinical Significance[J]. Med Sci Monit, 2018, 24:5881-5886.
[49]	Mihlan M, Blom AM, Kupreishvili K, et al. Monomeric C-reactive protein modulates classic complement activation on necrotic cells[J]. FASEB J, 2011, 25(12):4198-4210. doi: 10.1096/fj.11-186460 pmid: 21856781
[50]	Christophi C, McDermott F, Hughes ES. Prognostic significance of the absolute lymphocyte count in acute pancreatitis[J]. Am J Surg, 1985, 150(3):295-296. pmid: 4037189
[51]	Huang L, Chen C, Yang L, et al. Neutrophil-to-lymphocyte ratio can specifically predict the severity of hypertriglyceridemia-induced acute pancreatitis compared with white blood cell[J]. J Clin Lab Anal, 2019, 33(4):e22839.
[52]	Curley PJ, McMahon MJ, Lancaster F, et al. Reduction in circulating levels of CD4-positive lymphocytes in acute pancreatitis: Relationship to endotoxin, interleukin 6 and disease severity[J]. Br J Surg, 1993, 80(10):1312-1315.
[53]	Bommireddy R, Saxena V, Ormsby I, et al. TGF-beta 1 regulates lymphocyte homeostasis by preventing activation and subsequent apoptosis of peripheral lymphocytes[J]. J Immunol, 2003, 170(9):4612-4622. pmid: 12707339
[54]	Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill[J]. Bratisl Lek Listy, 2001, 102(1):5-14. pmid: 11723675

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