Gauri Kumbhar, Reuben Thomas Kurien, A J Joseph, Ebby George Simon, Amit Kumar Dutta, Ashish Goel, David Whitcomb, Sudipta DharChowdhury
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The ability of NLR and procalcitonin to differentiate infections from sterile inflammation in the first week was assessed.</p><p><strong>Results: </strong>Of 505 AP patients, 150 developed fevers. 48 (32%) had sterile inflammation, while 102 (68%) had infections. Most patients (n = 98, 65.3%) developed fever during the first week of illness (sterile inflammation (n = 43) and infections (n = 55)). NLR demonstrated good accuracy in differentiating infections from sterile inflammation in the first week (AUROC 0.70, p = 0.001), outperforming procalcitonin (AUROC 0.54, p = 0.58). Within infections (n = 102), 44 (43.1%) had infected pancreatic necrosis, 68 (66.7%) had extra-pancreatic infections, and 10 (9.8%) had both. Lower respiratory tract infection was the most common extra-pancreatic infection. Of 54 patients with culture-positive infections, 36 (66.7%) had grown multidrug-resistant (MDR) organisms. Fungal isolates were identified in 5 patients. Patients with infections had higher SAE incidence (21.6% vs. 4.2%, p = 0.007) than those with inflammation. The SAE incidence was higher with MDR infections than those without MDR (37.5% vs. 9.3%, p < 0.01).</p><p><strong>Conclusions: </strong>Infections in AP occur early in the course of illness. NLR could serve as a reliable biomarker to distinguish infections from sterile inflammation in the early course of AP, aiding timely management. Patients with MDR infections have higher serious adverse outcomes.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Neutrophil-to-Lymphocyte Ratio Differentiates Infections from Sterile Inflammation in First Week of Acute Pancreatitis.\",\"authors\":\"Gauri Kumbhar, Reuben Thomas Kurien, A J Joseph, Ebby George Simon, Amit Kumar Dutta, Ashish Goel, David Whitcomb, Sudipta DharChowdhury\",\"doi\":\"10.1007/s10620-024-08812-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Differentiating infections from sterile inflammation is crucial in early AP management.</p><p><strong>Aim: </strong>This study aimed to assess the capability of Neutrophil-to-Lymphocyte Ratio (NLR) and procalcitonin to differentiate between sterile inflammation and infections in the first week of AP and to analyze the source, microbiological profile, and impact of infections in AP.</p><p><strong>Methods: </strong>Consecutive patients presenting within 5 days of symptom onset were included. Microbiological profiles and serious adverse events (SAEs: in-hospital mortality or discharge in critical state) were analyzed. Blood count obtained at fever onset was used for calculating the NLR. The ability of NLR and procalcitonin to differentiate infections from sterile inflammation in the first week was assessed.</p><p><strong>Results: </strong>Of 505 AP patients, 150 developed fevers. 48 (32%) had sterile inflammation, while 102 (68%) had infections. Most patients (n = 98, 65.3%) developed fever during the first week of illness (sterile inflammation (n = 43) and infections (n = 55)). NLR demonstrated good accuracy in differentiating infections from sterile inflammation in the first week (AUROC 0.70, p = 0.001), outperforming procalcitonin (AUROC 0.54, p = 0.58). Within infections (n = 102), 44 (43.1%) had infected pancreatic necrosis, 68 (66.7%) had extra-pancreatic infections, and 10 (9.8%) had both. Lower respiratory tract infection was the most common extra-pancreatic infection. Of 54 patients with culture-positive infections, 36 (66.7%) had grown multidrug-resistant (MDR) organisms. Fungal isolates were identified in 5 patients. Patients with infections had higher SAE incidence (21.6% vs. 4.2%, p = 0.007) than those with inflammation. The SAE incidence was higher with MDR infections than those without MDR (37.5% vs. 9.3%, p < 0.01).</p><p><strong>Conclusions: </strong>Infections in AP occur early in the course of illness. NLR could serve as a reliable biomarker to distinguish infections from sterile inflammation in the early course of AP, aiding timely management. 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引用次数: 0
摘要
背景：区分感染与无菌性炎症是早期AP治疗的关键。目的：本研究旨在评估中性粒细胞与淋巴细胞比值（NLR）和降钙素原在AP第一周无菌性炎症和感染的区分能力，并分析AP感染的来源、微生物特征和影响。方法：纳入症状出现后5天内连续出现的患者。分析了微生物学概况和严重不良事件（SAEs：住院死亡率或危重出院）。发热时的血细胞计数用于计算NLR。评估NLR和降钙素原在第一周区分感染和无菌炎症的能力。结果：505例AP患者中，150例出现发热。无菌性炎症48例（32%），感染102例（68%）。大多数患者（n = 98, 65.3%）在发病第一周出现发热（无菌炎症（n = 43）和感染（n = 55））。NLR在区分感染和无菌性炎症的第一周具有良好的准确性（AUROC为0.70,p = 0.001），优于降钙素原（AUROC为0.54,p = 0.58）。在感染病例（n = 102）中，44例（43.1%）为感染性胰腺坏死，68例（66.7%）为胰腺外感染，10例（9.8%）为两者兼有。下呼吸道感染是最常见的胰外感染。在54例培养阳性感染患者中，36例（66.7%）生长出耐多药（MDR）细菌。5例患者中检出真菌分离株。感染患者SAE发生率高于炎症患者（21.6% vs. 4.2%, p = 0.007）。MDR感染的SAE发生率高于无MDR感染的SAE发生率（37.5% vs. 9.3%）， p结论：AP感染发生在病程早期。在AP早期，NLR可作为区分感染与无菌性炎症的可靠生物标志物，有助于及时治疗。耐多药感染患者有较高的严重不良后果。
Neutrophil-to-Lymphocyte Ratio Differentiates Infections from Sterile Inflammation in First Week of Acute Pancreatitis.
Background: Differentiating infections from sterile inflammation is crucial in early AP management.
Aim: This study aimed to assess the capability of Neutrophil-to-Lymphocyte Ratio (NLR) and procalcitonin to differentiate between sterile inflammation and infections in the first week of AP and to analyze the source, microbiological profile, and impact of infections in AP.
Methods: Consecutive patients presenting within 5 days of symptom onset were included. Microbiological profiles and serious adverse events (SAEs: in-hospital mortality or discharge in critical state) were analyzed. Blood count obtained at fever onset was used for calculating the NLR. The ability of NLR and procalcitonin to differentiate infections from sterile inflammation in the first week was assessed.
Results: Of 505 AP patients, 150 developed fevers. 48 (32%) had sterile inflammation, while 102 (68%) had infections. Most patients (n = 98, 65.3%) developed fever during the first week of illness (sterile inflammation (n = 43) and infections (n = 55)). NLR demonstrated good accuracy in differentiating infections from sterile inflammation in the first week (AUROC 0.70, p = 0.001), outperforming procalcitonin (AUROC 0.54, p = 0.58). Within infections (n = 102), 44 (43.1%) had infected pancreatic necrosis, 68 (66.7%) had extra-pancreatic infections, and 10 (9.8%) had both. Lower respiratory tract infection was the most common extra-pancreatic infection. Of 54 patients with culture-positive infections, 36 (66.7%) had grown multidrug-resistant (MDR) organisms. Fungal isolates were identified in 5 patients. Patients with infections had higher SAE incidence (21.6% vs. 4.2%, p = 0.007) than those with inflammation. The SAE incidence was higher with MDR infections than those without MDR (37.5% vs. 9.3%, p < 0.01).
Conclusions: Infections in AP occur early in the course of illness. NLR could serve as a reliable biomarker to distinguish infections from sterile inflammation in the early course of AP, aiding timely management. Patients with MDR infections have higher serious adverse outcomes.
期刊介绍：
Digestive Diseases and Sciences publishes high-quality, peer-reviewed, original papers addressing aspects of basic/translational and clinical research in gastroenterology, hepatology, and related fields. This well-illustrated journal features comprehensive coverage of basic pathophysiology, new technological advances, and clinical breakthroughs; insights from prominent academicians and practitioners concerning new scientific developments and practical medical issues; and discussions focusing on the latest changes in local and worldwide social, economic, and governmental policies that affect the delivery of care within the disciplines of gastroenterology and hepatology.
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