Background: Glucose metabolism and systemic inflammation have been associated with prognosis in acute pancreatitis (AP) patients. However, the possible value as a prognostic marker of the glucose-to-lymphocyte ratio (GLR) has not been evaluated in critically ill patients with AP.
Methods: This study included 1,133 critically ill patients with AP from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database, who were randomly divided into the training cohort (n=806) and the validation cohort (n=327) at a ratio of 7:3. X-tile software was used to determine the optimal cut-off values for GLR. Area under the curve (AUC) analysis was performed to compare the performance between GLR and other blood-based inflammatory biomarkers. Univariate and multivariate Cox regression analyses were applied to select prognostic factors associated with in-hospital mortality. A nomogram model was developed based on the identified prognostic factors and the validation cohort was used to further validate the nomogram.
Results: The optimal cut-off value for GLR was 0.9. The ROC analyses showed that the discrimination abilities of GLR were better than other blood-based inflammatory biomarkers. Multivariate Cox regression analysis demonstrated that age, platelet, albumin, bilirubin, Sequential Organ Failure Assessment (SOFA) score, and GLR are independent predictors of poor overall survival in the training cohort and were incorporated into the nomogram for in-hospital mortality as independent factors. The nomogram exhibited better discrimination with C-indexes in the training cohort and the validation cohort of 0.886 (95% CI=0.849– 0.922) and 0.841 (95% CI=0.767– 0.915), respectively. The calibration plot revealed an adequate fit of the nomogram for predicting the risk of in-hospital mortality in both sets.
Conclusion: As an easily available biomarker, GLR can independently predict the in-hospital mortality of critically ill patients with AP. The nomogram combining GLR with other significant features exerted favorable predictive performance for in-hospital mortality.



中文翻译：

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急性胰腺炎危重患者血糖与淋巴细胞比值的预后价值

背景：葡萄糖代谢和全身炎症与急性胰腺炎（AP）患者的预后有关。然而，尚未在患有 AP 的危重患者中评估葡萄糖与淋巴细胞比 (GLR) 作为预后标志物的可能价值。
方法：这项研究包括来自医学信息集市重症监护-IV (MIMIC-IV) 数据库的 1,133 名 AP 重症患者，他们随机分为训练队列 (n=806) 和验证队列 (n=327)比例为 7:3。X-tile 软件用于确定 GLR 的最佳截止值。进行曲线下面积 (AUC) 分析以比较 GLR 和其他基于血液的炎症生物标志物之间的性能。应用单变量和多变量 Cox 回归分析来选择与住院死亡率相关的预后因素。基于确定的预后因素开发了列线图模型，并使用验证队列进一步验证列线图。
结果：GLR 的最佳截止值为 0.9。ROC分析表明，GLR的辨别能力优于其他基于血液的炎症生物标志物。多变量 Cox 回归分析表明，年龄、血小板、白蛋白、胆红素、顺序器官衰竭评估 (SOFA) 评分和 GLR 是训练队列中总生存率差的独立预测因素，并作为独立因素纳入住院死亡率列线图. 列线图在训练队列和验证队列中的 C 指数分别为 0.886（95% CI=0.849-0.922）和 0.841（95% CI=0.767-0.915）表现出更好的区分。校准图显示了列线图的充分拟合，可用于预测两组中的住院死亡率风险。
结论：作为一种容易获得的生物标志物，GLR 可以独立预测 AP 重症患者的住院死亡率。将 GLR 与其他重要特征相结合的列线图对住院死亡率具有良好的预测性能。