To construct a nomogram prediction model for postoperative pancreatitis and postoperative hyperamylasemia after endoscopic retrograde cholangiopancreatography based on hematological indicators
Objective To retrospectively study the risk factors of postoperative pancreatitis(PEP)and postoperative hyperamylasemia(PEH)in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP),and to construct a nomogram prediction model and to evaluate its predictive effect.Methods According to the level of amylase after ERCP,431 patients were divided into normal amylase group(216 cases)and elevated amylase group(215 cases).General clinical data and laboratory examination indexes of two groups were compared.Univariate and multivariate logistic regression analysis were used to evaluate the independent risk factors for PEP and PEH after ERCP.A nomogram prediction model for the risk of serum amylase elevation,PEP,and PEH after ERCP was constructed,and the calibration curve and receiver operating characteristic(ROC)were respectively used to evaluate the predictive performance.Results The incidence of PEP was 9.28％(40/431).Levels of neutrophils(NE)count,c-reactive protein(CRP),direct bilirubin(DBil),AST,ALT and systemic immune inflammation index(SII),neutrophil/lymphocyte ratio(NLR),monocyte/lymphocyte ratio(MLR),platelet/lymphocyte ratio(PLR)and neutrophil/monocyte ratio(NMR)in elevated amylase group were higher than those in normal amylase group,and age,levels of lymphocyte(LY)count and fibrinogen(FIB)were lower than those in normal amylase group(P＜0.05).Multivariate logistic regression analysis showed that age,NE count,SII and PLR were independent risk factors for postoperative amylase elevation after ERCP;NE count,DBil and NLR were independent risk factors for PEP after ERCP;age and PLR were independent influencing factors for PEH after ERCP(P＜0.05).The internal consistency index of the nomogram model for predicting the increased amylase after ERCP was 0.791(95％CI 0.752-0.832),and the ROC area under the curve(AUC)was 0.791(95％CI 0.749-0.833).The internal consistency index of the nomogram model for predicting PEP and PEH after ERCP were 0.815(95％CI 0.756-0.892)and 0.701(95％CI 0.633-0.764)respectively,the AUC values were 0.815(95％CI 0.750-0.880)and 0.701(95％CI 0.652-0.750)respectively,which indicating that models had high prediction efficiency.Conclusion The nomogram model based on hematological indicators can effectively predict the occurrence of PEP and PEH in patients undergoing ERCP,and optimize the clinical individualized treatment plan for patients.
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