Diagnostic value of inflammatory indices and triglycerides in hyperlipidemic acute pancreatitis.

OBJECTIVE

High triglyceride (TG) levels complicate the diagnosis of acute pancreatitis (AP) due to delayed lipid testing. This study evaluates the diagnostic value of inflammatory indices, particularly the platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI), for identifying hyperlipidemic acute pancreatitis (HLAP).

METHODS

A retrospective cohort study analyzed 140 AP patients (59 HLAP, 81 non-HLAP) admitted between January 2023 and December 2024. The HLAP group was further stratified into gray-zone (HLAP-G) and typical (HLAP-S) subgroups. Healthy controls (HC, n=80) and individuals with simple hypertriglyceridemia (HTG, n=80) were included for comparison. Inflammatory indices (PLR, SIRI, NLR, MLR, SII) were calculated from admission blood counts. Diagnostic performance was assessed using ROC analysis, and a combined model (PLR+SIRI+TG) was developed and validated in an external cohort. Dynamic changes of PLR and SIRI were evaluated at 1, 6, and 12 hours post-admission.

RESULTS

PLR, SIRI, and other indices were significantly higher in the HLAP group than in the non-HLAP, HTG, and HC groups (all P < 0.01), showing a stepwise increase from HC to HLAP-S. SIRI demonstrated the highest diagnostic efficacy for HLAP (AUC=0.973, sensitivity =91.5%, specificity =96.3%), followed by PLR (AUC=0.960). The combined model achieved the highest AUC (0.988), with external validation confirming generalizability (AUC=0.845). Dynamic profiles revealed peak PLR and SIRI at 6 hours post-admission. Multivariate analysis identified PLR and SIRI as independent risk factors for HLAP.

CONCLUSIONS

PLR and SIRI are valuable, easily accessible tools for early HLAP diagnosis. Their high diagnostic accuracy, particularly when combined with TG, provides a robust method for prompt identification and targeted therapy.