Dynamic nomogram for persistent organ failure in acute biliary pancreatitis: Development and validation in a retrospective study

Clinical effects of phospholipase D2 in attenuating acute pancreatitis

BACKGROUND

The objective of the current study was to elucidate the clinical mechanism through which phospholipase D2 (PLD2) exerted a regulatory effect on neutrophil migration, thereby alleviating the progression of acute pancreatitis.

AIM

To elucidate the clinical mechanism through which PLD2 exerted a regulatory effect on neutrophil migration, thereby alleviating the progression of acute pancreatitis.

METHODS

The study involved 90 patients diagnosed with acute pancreatitis, admitted to our hospital between March 2020 and November 2022. A retrospective analysis was conducted, categorizing patients based on Ranson score severity into mild (n = 25), moderate (n = 30), and severe (n = 35) groups. Relevant data was collected for each group. Western blot analysis assessed PLD2 protein expression in patient serum. Real-time reverse transcription polymerase chain reaction was used to evaluate the mRNA expression of chemokine receptors associated with neutrophil migration. Serum levels of inflammatory factors in patients were detected using enzyme-linked immunosorbent assay. Transwell migration tests were conducted to compare migration of neutrophils across groups and analyze the influence of PLD2 on neutrophil migration.

RESULTS

Overall data analysis did not find significant differences between patient groups (P > 0.05). The expression of PLD2 protein in the severe group was lower than that in the moderate and mild groups (P < 0.05). The expression level of PLD2 in the moderate group was also lower than that in the mild group (P < 0.05). The severity of acute pancreatitis is negatively correlated with PLD2 expression (r = -0.75, P = 0.002). The mRNA levels of C-X-C chemokine receptor type 1, C-X-C chemokine receptor type 2, C-C chemokine receptor type 2, and C-C chemokine receptor type 5 in the severe group are significantly higher than those in the moderate and mild groups (P < 0.05), and the expression levels in the moderate group are also higher than those in the mild group (P < 0.05). The levels of C-reactive protein, tumor necrosis factor-α, interleukin-1β, and interleukin-6 in the severe group were higher than those in the moderate and mild groups (P < 0.05), and the levels in the moderate group were also higher than those in the mild group (P < 0.05). The number of migrating neutrophils in the severe group was higher than that in the moderate and mild groups (P < 0.05), and the moderate group was also higher than the mild group (P < 0.05). In addition, the number of migrating neutrophils in the mild group combined with PLD2 inhibitor was higher than that in the mild group (P < 0.05), and the number of migrating neutrophils in the moderate group combined with PLD2 inhibitor was higher than that in the moderate group (P < 0.05). The number of migrating neutrophils in the severe group + PLD2 inhibitor group was significantly higher than that in the severe group (P < 0.05), indicating that PLD2 inhibitors significantly stimulated neutrophil migration.

CONCLUSION

PLD2 exerted a crucial regulatory role in the pathological progression of acute pancreatitis. Its protein expression varied among patients based on the severity of the disease, and a negative correlation existed between PLD2 expression and disease severity. Additionally, PLD2 appeared to impede acute pancreatitis progression by limiting neutrophil migration.

Association between neutrophil to high-density lipoprotein cholesterol ratio and disease severity in patients with acute biliary pancreatitis

BACKGROUND

The neutrophil to high-density lipoprotein cholesterol ratio (NHR) is independently associated with the severity of various diseases. However, its association with acute biliary pancreatitis (ABP) remains unknown.

METHODS

This study included 1335 eligible patients diagnosed with ABP from April 2016 to December 2022. Patients were divided into low- and high-NHR level groups using an optimal cut-off value determined utilizing Youden's index. Multivariate logistic regression analysis was used to investigate the correlation between NHR and ABP severity. Multivariate analysis-based limited restricted cubic spline (RCS) method was used to evaluate the nonlinear relationship between NHR and the risk of developing moderate or severe ABP.

RESULTS

In this study, multivariate logistic regression analysis indicated an independent association between NHR and ABP severity (p < .001). The RCS analysis showed a linear correlation between NHR and the risk of developing moderate or severe ABP (P for non-linearity > 0.05), and increased NHR was found to be independently associated with a more severe form of the disease.

CONCLUSIONS

Our study suggests that NHR is a simple and practical independent indicator of disease severity, serving as a potential novel predictor for patients with ABP.

Establishment and Validation of a Dynamic Nomogram for Persistent Organ Failure in Acute Biliary Pancreatitis: A Retrospective Study

Purpose

The objective of this study was to create a predictive model for the onset of persistent organ failure (POF) in individuals suffering from acute biliary pancreatitis (ABP) by utilizing indicators observed within 24 hours of hospital admission. Early detection of high-risk POF patients is crucial for clinical decision-making.

Patients and Methods

Clinical data and laboratory indicators within 24 hours of admission from ABP patients diagnosed at The First Affiliated Hospital of Wenzhou Medical University between January 1, 2016, and January 1, 2024 were collected and retrospectively analyzed. The Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression (stepwise regression) methods were employed to identify variables for constructing the prediction model. The prediction model's performance was evaluated using the area under the curve (AUC), calibration curve, and decision curve analysis (DCA). It was compared with other scoring systems such as SIRS, BISAP, APACHE II, CTSI, and MCTSI. Additionally, a web-based calculator was created to simplify the calculation process.

Results

Out of 324 ABP patients, 25 developed POF. Initial screening identified 18 variables; through LASSO regression and multivariable logistic regression analysis, five variables including BMI, Hb, ALB, Ca, and LIP were determined as independent predictors of POF. According to these factors to build prediction model, draw the nomogram. The AUC's receiver operating characteristic curve analysis demonstrated a significantly higher value in comparison to other scoring systems. Calibration curve and DCA show that the established model to predict the accuracy of POF is higher, clinical decision of net benefit is also higher. A network calculator utilizing this predictive model was developed.

Conclusion

A predictive model incorporating five risk indicators has been established exhibiting high discriminatory power and accuracy which aids in early identification of ABP patients at risk for developing POF. This holds significant value in guiding clinical decision-making.