Novel Inflammatory Markers and Their Association with the Severity of Hypertriglyceridemia-Associated Acute Pancreatitis.

OBJECTIVE

To investigate associations between novel inflammatory biomarkers and disease severity in Hypertriglyceridemia-associated acute pancreatitis (HTG-AP) and to evaluate their prognostic utility for risk stratification.

METHODS

This retrospective cohort study included 340 HTG-AP patients. Neutrophil-to-high-density lipoprotein Cholesterol Ratio (NHR), Monocyte-to-High-Density Lipoprotein Cholesterol Ratio (MHR), Lymphocyte-to-HDL cholesterol ratio (LHR), Platelet-to-high-density lipoprotein cholesterol ratio (PHR), Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and aggregate index of systemic inflammation (AISI) indices were calculated. Multivariable logistic regression (unadjusted/age-sex-adjusted/fully-adjusted models) was conducted, and ROC analysis was performed to determine the predictive performance for MSAP+SAP/SAP.

RESULTS

Among 340 HTG-AP patients (156 MAP, 130 MSAP, 54 SAP), novel inflammatory markers NHR, SII, SIRI, MHR, PHR, and AISI significantly increased with severity (P < 0.01). Restricted cubic splines revealed nonlinear associations of NHR, SII, AISI, MHR, and SIRI with MSAP+SAP risk (Overall P < 0.05; Nonlinear P < 0.05). In fully adjusted models: For each 1-unit increase in NHR, the OR was 1.06 (95% CI: 1.03-1.09; P < 0.001). Comparing the highest tertile (Q3) to the lowest (Q1), the OR was 6.03 (95% CI: 2.98-12.19; P < 0.001). MHR Q3 vs Q1: OR=4.52 (2.26-9.03; P < 0.001). SIRI Q3 vs Q1: OR = 3.12 (1.61-6.06; P < 0.001). SII Q3 vs Q1: OR 3.12-(1.61-6.04; P < 0.001). AISI Q3 vs Q1: OR = 2.74 (95% CI: 1.42-5.28; P = 0.003). LHR and PHR showed no statistically significant associations (P > 0.05). ROC analysis demonstrated that NHR was the best predictor of MSAP+SAP (AUC = 0.701; optimal cutoff = 14.484), outperforming other indices (SII: AUC = 0.666; LHR: AUC = 0.505).

CONCLUSION

NHR is a novel independent predictor of moderate-severe or severe HTG-AP, with the highest tertile conferring a 6.03-fold increased risk (95% CI: 2.98-12.19; P < 0.001) and an AUC of 0.701 for MSAP+SAP prediction. SII, MHR, SIRI, and AISI provide complementary prognostic value, supporting early risk stratification using NHR (cutoff = 14.484).