Routine laboratory parameters in patients with necrotizing pancreatitis by the time of operative pancreatic debridement: Food for thought

Table 1 General characteristics of study participants and preoperative manipulations

Characteristic	Value
Sex, age, severity scores
Male, n (%)	33 (62.3)
Female, n (%)	20 (37.7)
Age, yr [range]	43 [23-68]
APACHE II score	8
Marshall score	4
Mortality, %	19
Etiology, n (%)
Alcohol	42 (79)
Biliary	4 (7)
Posttraumatic	4 (7)
Idiopathic	3 (5)
Comorbidity, n (%)
Multiple organ failure	5 (9)
Cardiovascular	11 (20)
Renal	4 (7)
Respiratory	10 (18)
Pneumonia	12 (22)
Necrosis infection	53 (100)
Extrapancreatic infection	53 (100)
Sepsis	8 (15)
Preoperative interventions
Laparocentesis	53
Thoracocentesis	31
Percutaneous drain	147
Endoscopic	33

Table 2 The dynamic changes of laboratory variables in the survivors with different Length of stay in hospital

Laboratory variable	Post-OPD LOS ≤ 50 d, n = 12	post-OPD LOS ≥ 50 d, n = 31
Hgb (g/L)
Day 1 (A)	111.4 ± 12.1	176.3 ± 31.2a
Day 3-9 (B)	93.6 ± 8.9	116.4 ± 26.6
Δ (B-A)	-35.5 ± 12.9	-46.4 ± 7.5
Day before OPD (E)	89.4 ± 7.8	83.6 ± 7.2
Δ (E-A)	-22.0 ± 11.4	-79.2 ± 12.0a
WBC (× 109/L)
Day 1 (A)	9.6 ± 3.9	11.5 ± 1.7
Day 3-9 (B)	16.5 ± 9.8	13.1 ± 4.6
Δ (B-A)	3.6 ± 6.3	-0.6 ± 6.6
Day before OPD (E)	10.1 ± 2.5	13.8 ± 4.7
Δ (E-A)	0.6 ± 2.4	2.4 ± 4.3
PLT (× 109/L)
Day 1 (A)	236.5 ± 57.8	223.5 ± 64.2
Day 3-9 (B)	453.5 ± 58.3	224.0 ± 44.5a
Δ (B-A)	232.8 ± 50.9	-7.5 ± 57.8a
Day before OPD (E)	648.0 ± 74.7	360.2 ± 104.8a
Δ (E-A)	430.5 ± 76.4	181.0 ± 48.7a
AST (μkat/L)
Day 1 (A)	0.56 ± 0.31	0.99 ± 0.35
Day 3-9 (B)	0.44 ± 0.06	0.72 ± 0.13a
Δ (B-A)	-0.18 ± 0.27	-0.84 ± 0.41
Day before OPD (E)	0.36 ± 0.11	0.42 ± 0.19
Δ (E-A)	-0.19 ± 0.28	-1.0 ± 1.0
ALT (μkat/L)
Day 1 (A)	0.71 ± 0.52	1.79 ± 1.31
Day 3-9 (B)	0.46 ± 0.18	1.02 ±0.52a
Δ (B-A)	-0.34 ± 0.43	-1.32 ± 0.84
Day before OPD (E)	0.51 ± 0.22	0.51 ± 0.16
Δ (E-A)	-0.21 ± 0.39	-1.28 ± 1.24
DB (μmol/L)
Day 1 (A)	15.73 ± 19.79	14.95 ± 11.53
Day 3-9 (B)	3.21 ± 0.87	6.78 ± 4.37
Δ (B-A)	-18.5 ± 22.19	-10.02 ± 10.81
Day before OPD (E)	1.72 ± 1.01	2.55 ± 0.74
Δ (E-A)	-14.02 ± 19.79	-12.4 ± 11.53
AML (U/L)
Day 1 (A)	65.8 ± 48.07	56.3 ± 24.47
Day 3-9 (B)	26.62 ± 8.11	38.94 ± 27.03
Δ (B-A)	-32.34 ± 43.11	-17.36 ± 16.55
Day before OPD (E)	21.18 ± 4.85	27.46 ± 16.61
Δ (E-A)	-44.62 ± 47.55	-28.84 ± 41.51

^aP ≤ 0.05 as compared to patients with post-OPD LOS ≤ 50 d. A: Day 1 (on admission); B: Day 3-7; C: Day 12-16; D: Day 21-24; E: Day before the operative pancreatic debridement. ALT: Alanine aminotransferase; AML: α-amylase; AST: Aspartate aminotransferase; DB: Direct bilirubin; Hgb: Hemoglobin; LOS: Length of stay in hospital; OPD: Operative pancreatic debridement; PLT: Total platelets count; WBC: Total white blood cell count.

Table 3 Logistic regression analysis of laboratory variables to differentiate survivors and non-survivors

Variable	OR	95%CI	P value
AST (E), μkat/L	1.0377	1.6514-1.3392	0.3612
α-amylase (E), U/L	0.8771	0.7657-1.0046	0.7543
DB (E), μmol/L	2.2201	1.0475-4.7051	0.6374
DB (A/E)	0.6941	0.4613-1.0445	0.5221

A: Day 1 (on admission); E: Day before the operative pancreatic debridement. AST: Aspartate aminotransferase; CI: Confidential intervals; DB: Direct bilirubin; OR: Odds ratio.

Table 4 Predictive value of laboratory variables for hospital mortality in acute necrotizing pancreatitis patients

Variables	Cutoff	Sensitivity	Specificity	AUC	95%CI	PPV	NPV	P value
AST (E), μkat/L	> 0.53	33.3%	92.0%	0.727	0.547-0.865	60.0%	79.3%	0.016
α-amylase (E), U/L	≤ 17.2	66.7%	84.0%	0.729	0.550-0.866	60.0%	87.5%	< 0.032
DB (E), μmol/L	> 4.2	44.4%	100.0%	0.782	0.608-0.905	100.0%	83.3%	< 0.001
DB(A/E)	≤ 1	22.2%	95.8%	0.764	0.584-0.894	66.7%	76.7%	0.0015

A: Day 1 (on admission); E: Day before the operative pancreatic debridement. ANP: Acute necrotizing pancreatitis; AST: Aspartate aminotransferase; AUC: area under the curve; CI: Confidential intervals; DB: Direct bilirubin; NPV: negative predictive values; PPV: positive predictive values.

Table 5 Predictive value of combined variables for hospital mortality in acute necrotizing pancreatitis patients

Multivariable model	AUC	95%CI	P value
AST (E) + AML (E)	0.791	0.618-0.911	0.016
AST (E) + DB (E)	0.784	0.610-0.906	0.0011
AML (E) + DB (E)	0.884	0.777-0.908	0.0002
AST (E) + AML (E) + DB (E)	0.884	0.728-0.968	0.003
DB (E) + DB (A/E)	0.87	0.708-0.961	0.0006
AST (E) + DB (A/E)	0.87	0.708-0.961	0.0016
AML (E) + DB (A/E)	0.84	0.674-0.945	0.0026
AST (E) + AML (E) + DB (A/E)	0.88	0.719-0.966	0.0023
AST (E) + AML (E) + DB (E) + DB (A/E)	0.935	0.792-0.991	0.0005

A: Day 1 (on admission); E: Day before the operative pancreatic debridement. ANP: Acute necrotizing pancreatitis; AST: Aspartate aminotransferase; CI: Confidential intervals; DB: Direct bilirubin.