Neutrophil CD64 index as a new early predictive biomarker for infected pancreatic necrosis in acute pancreatitis.

OBJECTIVE: Infectious pancreatic necrosis (IPN) is a serious complication of acute pancreatitis, and early recognition and timely intervention are the keys to improving clinical outcomes. The purpose of this study was to investigate the predictive capacity of the neutrophil CD64 index (nCD64 index) on IPN in patients with acute pancreatitis METHODS: This study comprises two independent cohorts: the training cohort consisted of 202 patients from Hunan Provincial People's Hospital, and the validation cohort consisted of 100 patients from Changsha Central Hospital. Peripheral blood samples were collected on the day of admission and on the 3rd, 5th, 7th, and 10th days of hospitalization, and the nCD64 index was detected by flow cytometry. Additionally, relevant clinical characteristics and laboratory biomarkers were collected and analyzed. RESULTS: We observed that nCD64 index on admission was significantly higher in the IPN group than Non-IPN group (p < 0.001). In the training cohort, a higher occurrence rate of IPN was observed in the high nCD64 index group compared to the moderate and low nCD64 index group (p < 0.001). Further analysis showed that nCD64 index was significant positive correlated with the incidence rate of IPN (p < 0.001, correlation coefficient = 0.972). Furthermore, logistic regression analysis showed that high expression of the nCD64 index on admission was a risk factor for the occurrence of IPN (OR = 2.971, p = 0.038). We further found that the nCD64 index of IPN patients was significantly higher than the Non-IPN patients on the days 1, 3, and 5 after admission, and the nCD64 index of IPN patients before and after the onset (p < 0.05). At the same time, this study revealed that the nCD64 index on admission showed good predictive efficacy for IPN (AUC = 0.859, sensitivity = 80.8%, specificity = 87.5%), which was comparable to APACHE II score. And this finding was further validated in an independent cohort of 100 participants (AUC = 0.919, Sensitivity = 100.0%, Specificity = 76.6%). CONCLUSION: This study demonstrated the clinical value of nCD64 index in patients with IPN patients for the first time through two independent cohort studies. The nCD64 index can be used as an early prediction and risk assessment tool for the occurrence of IPN, contributing to the improvement of patient outcomes and efficiency of medical resource allocation.

Clinical Characteristics of Aortic Aneurysm in MIMIC-III.

BACKGROUND: Aortic aneurysm (AA) is an aortic disorder prone to sudden, life-threatening aortic dissection or rupture, with poor clinical outcomes. In this study, we aimed to analyze the clinical characteristics of AA in MIMIC-III to explore implications for management. METHODS: All patients with AA, including abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA), in the MIMIC-III database were included. Clinical and laboratory variables were analyzed and compared in AAA and TAA. RESULTS: A total of 345 patients, including 183 patients with AAA and 162 patients with TAA, were enrolled in this study. The in-hospital mortality in AAA and TAA groups was 6.01% and 3.7%, respectively. In the nonsurvivor groups in both AAA and TAA, patients were older, and the incidence of surgery was lower. In the nonsurvivor group of AAA, the levels of alanine aminotransferase, aspartate aminotransferase, urea nitrogen, creatinine, lactate dehydrogenase (LDH), creatine kinase, anion gap, and lactate were significantly higher in the nonsurvivor group, whereas the level of albumin was lower. In the nonsurvivor group of TAA, the level of LDH significantly increased and the level of albumin decreased. In the nonsurgery group, in-hospital mortality was higher, and patients were older, with higher levels of glucose, total bilirubin, urea nitrogen, and creatinine and longer length of stay in ICU and hospital. CONCLUSION: Age, surgery, albumin, and LDH showed significant differences between survivor and nonsurvivor groups in both AAA and TAA. In the nonsurgery group, the mean age was older and disease severity was worse, with poorer clinical outcomes. Older AA patients without surgery and with lower levels of albumin and higher levels of LDH had higher risk of in-hospital mortality.

Establishment and Validation of an Early Predictive Model for Severe Acute Pancreatitis.

Objective: The purpose of this study is to establishment and validation of an early predictive model for severe acute pancreatitis (SAP). Methods: From January 2015 to August 2022, 2986 AP patients admitted to Changsha Central Hospital were enrolled in this study. They were randomly divided into a modeling group (n = 2112) and a validation group (n = 874). In the modeling group, identify risk factors through logistic regression models and draw column charts. Use internal validation method to verify the accuracy of column chart prediction. Apply calibration curves to evaluate the consistency between nomograms and ideal observations. Draw a DCA curve to evaluate the net benefits of the prediction model. Results: Nine variables including respiratory rate, heart rate, WBC, PDW, PT, SCR, AMY, CK, and TG are the risk factors for SAP. The column chart risk prediction model which was constructed based on these 9 independent factors has high prediction accuracy (modeling group AUC = 0.788, validation group AUC = 7.789). The calibration curve analysis shows that the prediction probabilities of the modeling and validation groups are consistent with the observation probabilities. By drawing a DCA curve, it shows that the model has a wide threshold range (0.01-0.88). Conclusion: The study developed an intuitive nomogram containing readily available laboratory parameters to predict the incidence rate of SAP.