Value of serum apolipoprotein A1 versus apolipoprotein B-to-apolipoprotein A1 ratio in predicting severe acute pancreatitis

Objective To investigate the blood lipid parameters for the early prediction of severe acute pancreatitis( SAP) and their predictive value. Methods A retrospective analysis was performed for the clinical data of 425 patients with acute pancreatitis( AP) who were admitted to The Affiliated Hospital of Southwest Medical University from January 2017 to January 2019,among whom there were 229 patients with mild acute pancreatitis( MAP),161 patients with moderate-severe acute pancreatitis( MSAP),and 35 patients with severe acute pancreatitis( SAP). Blood lipid levels were collected for all patients within the first 24 hours after admission. A one-way analysis of variance and the Kruskal-Wallis H test were used for comparison of continuous data between multiple groups. A logistic regression analysis was used for the variables with statistical significance determined by the univariate analysis. The Spearman correlation was used to investigate the correlation between data. The receiver operating characteristic( ROC) curve was used to evaluate the diagnostic efficiency of indices,and Med Calc software was used to investigate whether there was a significant difference in diagnostic efficiency. Results There were significant differences in apolipoprotein A1( ApoA1) and apolipoprotein B-to-apolipoprotein A1( Apo B/A1) ratio between the patients with different severities of acute pancreatitis( F = 46. 290,χ2= 9. 130,both P < 0. 05). Apo B/A1 ratio was positively correlated with Atlanta grade,Ranson score,MCTSI score,and BISAP score( r = 0. 296,0. 129,0. 303,and 0. 284,all P < 0. 05). ApoA1 was negatively correlated with Atlanta grade,Ranson score,MCTSI score,and BISAP score( r =-0. 407,-0. 176,-0. 338,and-0. 285,all P < 0. 05). Apo B/A1 ratio was an independent risk factor for SAP( odds ratio = 4. 493,95% confidence interval [CI]: 1. 399-14. 427,P = 0. 012),while ApoA1 was an independent protective factor for SAP( odds ratio = 0. 004,95% CI: 0-0. 034,P < 0. 001). Apo B/A1 ratio had an area under the ROC curve ( AUC) of 0. 763( 95% CI: 0. 675-0. 851,P <0. 001) in predicting SAP,and ApoA1 had an AUC of 0. 862( 95% CI: 0. 809-0. 916,P <0. 001) in predicting SAP,suggesting that ApoA1 had a higher diagnostic value( Z = 2. 183,P = 0. 029). Conclusion Both serum ApoB/A1 ratio and ApoA1 have a certain value in predicting SAP,and ApoA1 has a higher predictive value than ApoB/A1 ratio.