The correlation of serum LDH and AMY with short-term prognosis in the patients with severe acute pancreatitis

Hu Yulong; Wang Zhizhou

doi:10.3969/j.issn.1002-1949.2024.10.009

Abstract：Objective To explore the correlation of the expression of serum lactate dehydrogenase(LDH)and amylase(AMY)with the short-term prognosis in the patients with severe acute pancreatitis.Methods A retrospective study was conducted to collect the data from 143 patients with severe acute pancreatitis who were diagnosed and treated in Fuyang People's Hospital from March 2019 to February 2024.According to the patient's survival status within 2 weeks of admission,the patients were divided into a good prognosis group(n=111)and a poor prognosis group(n=32).The serum LDH,AMY expression and other data of patients with different short-term prognosis at admission were compared.The relationship of serum LDH and AMY expression with short-term prognosis in the patients with severe acute pancreatitis was analyzed by restricted cubic spline method.The interaction of serum LDH and AMY expression on short-term prognosis of patients with severe acute pancreatitis was analyzed.The receiver operating characteristic(ROC)curve and decision curve analysis were drawn to analyze the value of serum LDH and AMY in predicting short-term prognosis of patients with severe acute pancreatitis.Results The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores,serum LDH and AMY levels were higher in the poor prognosis group than in the good prognosis group at admission(P＜0.05).After restricted cubic spline analysis,the results showed a positive linear dose-response relationship between the risk of short-term poor prognosis in the patients with severe acute pancreatitis and the expression of serum LDH and AMY at admission(P＜0.05).When serum LDH ≥ 510.05 U/L and AMY ≥712.89 U/L,the risk of short-term poor prognosis in the patients increased with the increase of their expression.The interaction analysis found that serum LDH and AMY had a positive interaction effect on short-term poor prognosis in the patients with severe acute pancreatitis.The risk of short-term poor prognosis in the patients with high expression(LDH ≥510.05 U/L,AMY≥712.89 U/L)were 19.421 times higher than those with low expression(LDH＜510.05 U/L,AMY＜712.89 U/L).The ROC curve was plotted,and the results showed that serum LDH and AMY alone and in combination predicted the short-term prognosis of patients with severe acute pancreatitis with both the area under curve(AUC)＞0.7,indicating a certain predictive value.The value of combined prediction was higher than that of LDH and AMY alone(all P＜0.05).Decision curve analysis was drawn,and the results showed that when the threshold was in the range of 0-0.04 and 0.07-1.00,the combined prediction model of serum LDH and AMY had a better net benefit rate in predicting the short-term adverse prognosis risk of severe acute pancreatitis patients than serum LDH and AMY alone.The maximum net benefit rate predicted by the combination of LDH and AMY was 0.224.Conclusions The short-term prognosis of patients with severe acute pancreatitis is related to abnormal expression of serum LDH and AMY,which can be used for predicting the risk of short-term poor prognosis in the patients with severe acute pancreatitis,and net benefit rate of the combination prediction is more ideal.