Values of the Acute Physiology and Chronic Health Evaluation Ⅱ score combined with serum glycated hemoglobin and lactate dehydrogenase in evaluating the severity and prognosis of patients with acute pancreatitis

Objective To investigate the values of the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, serum glycated hemoglobin (HbA1c) and lactate dehydrogenase (LDH) in evaluating the severity and prognosis of patients with acute pancreatitis (AP).

Methods A total of 120 patients with AP treated in the hospital from August 2019 to May 2022 were divided into mild group (n=33), moderately severe group (n=52), and severe group (n=35) according to the severity of the disease, and were also divided into survival group (n=86) and death group (n=34) based on prognosis. Pearson method was used to analyze the correlations of APACHE Ⅱ score with serum HbA1c and LDH levels in patients with AP; the Logistic regression analysis was used to determine the influencing factors of prognosis in patients with AP; the receiver operating characteristic (ROC) curve was used to evaluate the predictive values of APACHE Ⅱ score, HbA1c and LDH for the prognosis of AP.

Results The levels of serum triglycerides, HbA1c, LDH, APACHE Ⅱ score, and the Modified CT Severity Index (MCTSI) score gradually increased while high-densitylipoprotein cholesterol, low-density lipoprotein cholesterol, and serum calcium gradually decreased in the mild, moderately severe, and severe groups (P < 0.05). APACHE Ⅱ score and MCTSI score were positively correlated with serum HbA1c and LDH levels in patients with AP (P < 0.05). Triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum calcium, MCTSI score, HbA1c, LDH, and APACHE Ⅱ score were factors influencing poor prognosis in patients with AP (P < 0.05). The area under the curve for predicting poor prognosis in patients with AP by the combination of APACHE Ⅱ score, serum HbA1c and LDH levels was 0.930, with a sensitivity of 91.18% and a specificity of 83.72%, which was superior to each factor alone (Z_{combined-HbA1c}=3.511, Z_combined-LDH=4.798, Z_{combined-APACHE Ⅱ score}=2.134, P < 0.001, P < 0.001, P=0.033).

Conclusion Serum HbA1c and LDH levels are closely related to the severity of the disease, and their combination with APACHE Ⅱ score has good predictive value for the prognosis of patients with AP.