Construction and validation of the nomogram prediction model in the patients with severe acute pancreatitis complicated by persistent inflammation-immunosuppression-catabolism syndrome
Zheng Yun
Tu Qianqian
Zhang Afang
Zhang Hong
Abstract：Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio(NLR)combined with fibrinogen degradation product(FDP)/D-dimer ratio in the patients with severe acute pancreatitis(SAP)complicated or not by persistent inflammation-immunosuppression-catabolism syndrome(PICS)and to establish a prediction model.Methods The clinical data of 133 patients with SAP admitted to the intensive care unit,emergency medicine and gastroenterology departments of the First Affiliated Hospital of Anhui Medical University from May 2018 to May 2023 were retrospectively analyzed.Based on the PICS diagnostic criteria,the patients were divided into two groups:the SAP with PICS group(60 cases)and the SAP without PICS group(73 cases).The difference in NLR,FDP/D-dimer ratio and common clinical indicators between the two groups were statistically analyzed.Relevant clinical features,ICU mortality and survival rate after a one-year follow-up were compared between the two groups.Independent risk factors were identified by using Lasso regression and multivariate Logistic regression.A nomogram prediction model was constructed and was internally validated by using the receiver operating characteristic(ROC)curve and calibration curve.The clinical applicability of the model was evaluated by using a clinical decision curve analysis(DCA).Results Compared with SAP without PICS group,the SAP with PICS group had significantly higher modified Marshall scores,NLR,platelet-to-lymphocyte ratio(PLR)and FDP/D-dimer ratio(all P＜0.05).The proportion of bloodstream infection and abdominal infection was significantly higher in the SAP with PICS group than in the SAP without PICS group(P＜0.05).Multivariate Logistic regression analysis showed that NLR and FDP/D-dimer ratio were the independent risk factors for SAP with PICS(OR=0.790 and 0.131,P＜0.05).A three-factor Logistic regression model was developed by using predictor variables selected by Lasso regression.The predictor variables included FDP/D-dimer,NLR and C-reactive protein(CRP)/prealbumin(OR=1.981,1.048 and 4.726,respectively,all P＜0.05).The model was fitted by using above factors,the area under curve(AUC)of the nomogram model was 0.948(95％CI 0.909-0.980)after internal validation with the bootstrap method.The calibration curve closely approximated the reference curve,and the clinical DCA indicated that the prediction model has good clinical applicability.Conclusions The nomogram prediction model constructed based on the NLR,FDP/D-dimer and CRP/prealbumin has discrimination,calibration and practicality in the patients of SAP complicated by PICS.These ratios can be used to evaluate whether the patients with SAP are likely to develop PICS,which may indicate a poor prognosis for the patients of SAP complicated by PICS.
Keywords：Severe acute pancreatitis(SAP)Persistent inflammation-immunosuppression-catabolism syndrome(PICS)Neutrophil-to-lymphocyte ratio(NLR)Fibrinogen degradation product/D-dimer ratioC-reactive protein/prealbumin
Publication Date：2024-10-10
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 890-896 )