Effect of octreotide combined with ulinastatin on the creatinine-to-albumin ratio and systemic immune-inflammation index in patients with severe acute pancreatitis.

OBJECTIVE

To evaluate the effects of combined octreotide and ulinastatin therapy on the serum creatinine-to-albumin ratio (CAR) and systemic immune-inflammation index (SII) in patients with severe acute pancreatitis (SAP), and to investigate its impact on inflammatory markers, organ function, and clinical outcomes.

METHODS

This single-center, retrospective cohort study included 240 SAP patients admitted to Northwest University Affiliated Xi'an No. 3 Hospital between October 2021 and April 2023. The control group (n=112) received octreotide 0.1 mg subcutaneously every 8 hours, while the observation group (n=128) received ulinastatin 100,000 U intravenously once daily for 7-14 days. Primary outcomes included 28-day mortality, Intensive care unit (ICU) stay, hospital stay, and 1-year recurrence. Secondary outcomes included CAR, SII, creatinine (Cr), serum amylase, albumin (Alb), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6), measured on days 1, 3, 7, and 14. Complications and adverse events were recorded based on standardized criteria.

RESULTS

From days 1 to 14, the observation group exhibited larger reductions in CAR and SII, lower Cr, CRP, PCT, and IL-6, and higher Alb (all P<0.05). Combined therapy reduced the 28-day mortality (P=0.038), 1-year recurrence (P=0.016), and the overall complication rate (P=0.003). Day-14 CAR and SII effectively predicted 28-day mortality and 1-year recurrence with an area under the curve greater than 0.7.

CONCLUSIONS

The addition of ulinastatin to octreotide therapy in SAP significantly reduces inflammation and organ injury, improving short-term survival and decreasing mid-term recurrence. CAR and SII are promising prognostic biomarkers.