OBJECTIVES: Hypertriglyceridemic acute pancreatitis (HTG-AP) has a rapid onset and is associated with a high risk of progression and recurrence. Early identification of patients at risk of severe disease can help reduce the likelihood of multiple organ failure and mortality. This study aims to investigate the changes in inflammatory composite markers and D-dimer (D-D) levels in young and middle-aged/elderly patients with HTG-AP and to evaluate their predictive value for disease progression. METHODS: A total of 230 patients with HTG-AP admitted to Chongqing University Jiangjin Hospital (Jiangjin Central Hospital) between 2017 and 2023 were retrospectively enrolled. Patients were first divided into a young group (≤45 years) and a middle-aged/elderly group (>45 years), and then stratified into mild and severe groups based on disease severity. Inflammatory composite markers, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), C-reactive protein-to-lymphocyte ratio (CLR), systemic inflammation response index (SIRI), systemic immune inflammation index (SII), as well as D-D levels, were compared among groups. Least absolute shrinkage and selection operator (LASSO) regression and Logistic regression were used to identify independent risk factors for disease progression in each age group. Receiver operating characteristic (ROC) curves and the DeLong test were used to assess and compare the predictive performance (area under the curve, AUC) of risk factors. Internal validation was performed using the bootstrap method (n=1 000). RESULTS: No significant differences in NLR, PLR, MLR, SIRI, SII, CLR, or D-D levels were observed between the young (n=127) and middle-aged/elderly (n=103) groups (all P>0.05). Among young patients, the severe group (n=59) had significantly higher NLR, SIRI, SII, CLR, and D-D levels compared to the mild group (n=68) (all P<0.05). Among middle-aged/elderly patients, CLR and D-D levels were significantly higher in the severe group (n=49) than in the mild group (n=54) (P<0.05). LASSO and Logistic regression analyses identified elevated D-D as an independent risk factor for disease progression in young patients (P=0.007, OR=1.458, 95% CI 1.107 to 1.920), while both D-D (P=0.001, OR=2.267, 95% CI 1.413 to 3.637) and CLR (P=0.003, OR=1.007, 95% CI 1.003 to 1.012) were independent risk factors in middle-aged/elderly patients. ROC analysis showed that D-D predicted disease progression in young and middle-aged/elderly patients with AUCs of 0.653 and 0.741, sensitivities of 67.8% and 57.1%, and specificities of 72.1% and 88.9%, respectively. CLR predicted progression in middle-aged/elderly patients with an AUC of 0.687, sensitivity of 63.3%, and specificity of 70.4%. DeLong test showed no significant difference in AUC between D-D and CLR for middle-aged/elderly patients (Z=0.993, P=0.321). Internal validation via bootstrap analysis yielded a D-D AUC of 0.732, with sensitivity and specificity of 68.1% and 91.0%, respectively. CONCLUSIONS Differences in inflammatory response and coagulation function exist across age groups and disease severities in HTG-AP patients. Elevated D-D is an independent predictor of disease progression in both young and middle-aged/elderly patients, while CLR also predicts progression in the latter group. D-D, in particular, demonstrates strong predictive value for severe disease in middle-aged/elderly patients with HTG-AP.
Humans ; Fibrin Fibrinogen Degradation Products/metabolism* ; Disease Progression ; Middle Aged ; Pancreatitis/etiology* ; Male ; Female ; Retrospective Studies ; Adult ; Biomarkers/blood* ; Hypertriglyceridemia/blood* ; Acute Disease ; Predictive Value of Tests ; Aged ; Inflammation ; C-Reactive Protein/analysis* ; Neutrophils ; Age Factors

Objective To analyze the clinical characteristics of patients with liver cirrhosis complicated with portal vein thrombosis (PVT) and to explore the high risk factors of PVT formation for the prevention and early treatment of PVT.Methods From January 2012 to August 2017,at the Second Hospital Affiliated to Chongqing Medical University,160 hospitalized liver cirrhosis patients complicated with PVT were selected as PVT group and secondary PVT caused by other factors were excluded.At the same time,250 patients with liver cirrhosis without PVT were enrolled as the control group.According to the history of splenectomy,the patients were divided into splenectomy group and non-splenectomy group.The risk factors correlated with the formation of PVT such as hemoglobin,platelet count,prothrombin time (PT),international normalized ratio (INR) and prothrombin activity were collected.T test,chisquare test and non-parameter rank test were performed for the comparison of above indexes between PVT group and control group.Single factor analysis and multifactor logistic regression were used to analyze the risk factors of PVT formation.Results The average age of patients in PVT group ((54.5 ±11.4) years) was significantly older than that in control group ((51.8±911.9) years,t=2.29,P=0.02).The results of multifactor logistic regression analysis showed that hemoglobin,platelet count,PT and INR were risk factors of PVT formation (all P＜0.05).The proportion of patients with Child-Pugh class C cirrhosis in PVTgroup was higher than that in control group (16.2％,26/160 vs.4.4％,11/250),and the difference was statistically significant (x2 =16.60,P＜0.01).In PVT group,27.5％ (44/160) patients had a history of splenectomy,and 8.4％ (21/250) patients of the control group had a history of splenectomy,and the difference between two groups was statistically significant (x2=26.70,P＜0.01).The platelet counts of patients with splenectomy were higher than those of patients without splenectomy ((176.2±98.7)× 109/L vs.(78.3±57.8) × 109/L),and the difference was statistically significant (t=11.08,P＜0.01).The incidence of complications in PVT group was much higher than that in control group (45.0％,72/160 vs.10.0％,25/250,x2=66.17,P＜0.05).There were no statistically significant differences in the incidence of gastrointestinal bleeding and mortality between PVT treatment group and non-treatment group (25.6％,11/43 vs.23.8％,10/42;18.6％,8/43 vs.31.0％,13/42,respectively;both P＞0.05).Conclusions Decreased hemoglobin,increased platelet count,prolonged PT,increased INR and Child-Pugh classification are the risk factors for PVT formation.Increased platelet after splenectomy is an independent risk factor for PVT formation.