Immature granulocytes: A novel biomarker of acute respiratory distress syndrome in patients with acute pancreatitis.

PURPOSE: To investigate the relationship between immature granulocyte percentage (IG%) and acute respiratory distress syndrome (ARDS) in patients with acute pancreatitis (AP). MATERIALS AND METHODS: A cohort of 2289 patients with AP was screened; 1933 were enrolled in this prospective multicenter study. Blood samples for IG% analysis were collected on admission and processed using a hematology analyzer. Demographic, radiological, and clinical laboratory data were prospectively collected and reviewed retrospectively. RESULTS: Increased IG% reflected significant upward tendency of ARDS incidence and severity. Multivariable logistic regression revealed that Acute Physiology and Chronic Health Evaluation (APACHE) II, CT severity index, C-reactive protein, white blood cells, granulocytes, lymphocytes, and IG% (OR 1.297 [95% CI 1.230-1.368]) were independent factors predicting ARDS onset in patients with AP. Receiver operating characteristic curve analysis revealed that area under the curve for APACHE II and IG% were 0.837 (95% CI 0.798-0.876) and 0.821 (95% CI 0.794-0.849), respectively. The combination of APACHE II score and IG% demonstrated excellent predictive power for ARDS incidence. CONCLUSIONS: IG% is a new type of biomarker for ARDS in patients with AP, which may promote timely and efficient identification of individuals at high risk for ARDS in the early stages of disease.