Association between neutrophil to high-density lipoprotein cholesterol ratio and disease severity in patients with acute biliary pancreatitis

Figures & data

Figure 1. Flow chart of the patient selection process.

Table 1. Baseline characteristics of patients with acute biliary pancreatitis.

Variables	All patients (n = 1335)	MAP (n = 1087)	Non-MAP (n = 248)	p-Value
Gender (n, %)				.282
Male	644 (48.2%)	532 (48.9%)	112 (45.2%)
Female	691 (51.8%)	555 (51.1%)	136 (54.8%)
Age (years)	60.8 ± 16.3	60.6 ± 16.2	61.4 ± 16.7	.484
Hypertension (n, %)				.030
Yes	475 (35.6%)	372 (34.2%)	103 (41.5%)
No	860 (64.4%)	715 (65.8%)	145 (58.5%)
Diabetes (n, %)				.295
Yes	218 (16.3%)	172 (15.8%)	46 (18.5%)
No	1117 (83.7%)	915 (84.2%)	202 (81.5%)
ALB (g/L)	35.6 ± 6.0	36.1 ± 5.8	33.0 ± 6.2	<.001
ALT (U/L)	78.0 (25.0–195.0)	85.0 (26.0–210.0)	46.5 (22.0–123.5)	<.001
AST (U/L)	48.0 (22.0–129.0)	50.0 (22.0–137.0)	38.5 (22.0–88.5)	.015
BUN (mmol/L)	5.3 (3.9–7.2)	5.2 (3.8–6.8)	6.3 (4.1–10.1)	<.001
Cr (µmol/L)	67.6 (54.7–83.2)	67.8 (54.9–81.2)	67.4 (51.6–99.1)	.218
GLU (mmol/L)	6.6 (5.2–8.7)	6.3 (5.0–8.1)	7.8 (5.9–10.6)	<.001
TC (mmol/L)	3.8 (3.1–4.6)	3.8 (3.3–4.6)	3.4 (2.6–4.3)	<.001
TG (mmol/L)	1.0 (0.6–1.6)	1.0 (0.6–1.6)	1.1 (0.7–1.6)	.026
HDL-C (mmol/L)	1.2 ± 0.4	1.2 ± 0.4	1.1 ± 0.4	<.001
LDL-C (mmol/L)	2.0 (1.5–2.6)	2.1 (1.6–2.6)	1.7 (1.3–2.4)	<.001
Ca (mmol/L)	2.0 ± 0.2	2.1 ± 0.2	1.9 ± 0.3	<.001
WBC (10^9/L)	10.9 (7.3–14.6)	10.4 (7.0–14.1)	13.2 (9.8–17.1)	<.001
NEUT (10^9/L)	9.0 (5.4–12.8)	8.5 (4.9–12.3)	11.8 (8.1–15.3)	<.001
LYM (10^9/L)	0.9 (0.7–1.3)	1.0 (0.7–1.4)	0.8 (0.6–1.2)	<.001
RDW (%)	13.3 (12.8–14.0)	13.2 (12.7–13.9)	13.6 (12.9–14.3)	<.001
PLT (10^9/L)	171.8 ± 67.1	171.2 ± 66.4	174.6 ± 70.0	.459
AMY (U/L)	468.0 (145.0–1122.0)	456.0 (145.0–1106.0)	563.5 (140.5–1168.8)	.480
LIP (U/L)	424.4 (105.0–954.4)	422.4 (110.5–961.7)	438.5 (90.9–894.2)	.569
NHR	7.5 (4.4–11.4)	6.8 (4.0–10.2)	11.0 (6.8–15.4)	<.001

Data are presented as numbers, mean ± standard deviation, median (25th–75th percentiles), or frequency [percentage (%)].

Abbreviations: MAP: mild acute biliary pancreatitis; non-MAP: moderate and severe acute biliary pancreatitis; ALB: albumin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; Cr: creatinine; GLU: glucose; TC: total cholesterol; TG: triglyceride; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; Ca: calcium; WBC: white blood count; NEUT: neutrophil; LYM: lymphocyte; RDW: red cell distribution width; PLT: platelet; AMY: amylase; LIP: lipase; NHR: neutrophil high-density lipoprotein cholesterol ratio.

Figure 2. Receiver operating curve of the NHR for prediction of disease severity in patients with acute biliary pancreatitis.

Table 2. Comparison of characteristics between high- and low-NHR groups.

Variables	Total (n = 1335)
	NHR < 9.54 (n = 869)	NHR > 9.54 (n = 466)	p-Value
Gender (n, %)			<.001
Male	384 (44.2%)	260 (55.8%)
Female	485 (55.8%)	206 (44.2%)
Age (years)	60.6 ± 16.1	61.1 ± 16.5	.540
Hypertension (n, %)			.004
Yes	285 (32.8%)	190 (40.8%)
No	584 (67.2%)	276 (59.2%)
Diabetes (n, %)			.090
Yes	131 (15.1%)	87 (18.7%)
No	738 (84.9%)	379 (81.3%)
ALB (g/L)	36.7 ± 5.5	33.5 ± 6.3	<.001
ALT (U/L)	82.0 (24.0–204.0)	68.5 (26.0–168.5)	.534
AST (U/L)	50.0 (22.0–133.0)	42.0 (22.8–116.3)	.265
BUN (mmol/L)	5.1 (3.8–6.6)	5.9 (4.2–8.8)	<.001
Cr (µmol/L)	66.8 (54.9–79.9)	69.1 (54.1–89.6)	.009
GLU (mmol/L)	6.2 (4.9–7.8)	7.4 (5.7–9.9)	<.001
TC (mmol/L)	3.9 (3.3–4.7)	3.5 (2.8–4.3)	<.001
TG (mmol/L)	0.9 (0.5–1.5)	1.1 (0.8–1.8)	<.001
HDL-C (mmol/L)	1.3 ± 0.4	1.0 ± 0.3	<.001
LDL-C (mmol/L)	2.1 (1.6–2.6)	1.9 (1.4–2.4)	<.001
Ca (mmol/L)	2.1 ± 0.2	2.0 ± 0.2	<.001
WBC (10^9/L)	8.4 (6.1–11.3)	15.4 (12.7–18.7)	<.001
NEUT (10^9/L)	6.6 (4.1–9.5)	13.8 (11.0–16.7)	<.001
LYM (10^9/L)	1.0 (0.7–1.4)	0.8 (0.6–1.2)	<.001
RDW (%)	13.2 (12.7–13.8)	13.5 (13.0–14.2)	<.001
PLT (10^9/L)	168.8 ± 62.4	177.4 ± 74.7	.025
AMY (U/L)	462.0 (156.0–1142.0)	484.0 (121.8–1025.5)	.262
LIP (U/L)	428.0 (110.8–997.8)	411.6 (93.6–852.5)	.161
NHR	5.3 (3.3–7.3)	13.5 (11.2–18.3)	<.001

Data are presented as numbers, mean ± standard deviation, median (25th–75th percentiles), or frequency [percentage (%)].

Abbreviations: NHR: neutrophil high-density lipoprotein cholesterol ratio; ALB: albumin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; Cr: creatinine; GLU: glucose; TC: total cholesterol; TG: triglyceride; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; Ca: calcium; WBC: white blood count; NEUT: neutrophil; LYM: lymphocyte; RDW: red cell distribution width; PLT: platelet; AMY: amylase; LIP: lipase.

Table 3. NHR is independently associated with the severity of patients with acute biliary pancreatitis in multivariate analyses.

Variables	OR	95% CI	p-Value
Hypertension			.31
No	Ref
Yes	0.842	0.601–1.173
ALB (g/L)	0.974	0.946–1.003	.08
ALT (U/L)	0.999	0.998–1.000	.14
BUN (mmol/L)	1.089	1.034–1.149	<.01
Cr (µmol/L)	1.001	0.996–1.004	.792
GLU (mmol/L)	1.129	1.077–1.185	<.001
TC (mmol/L)	0.936	0.784–1.101	.439
LDL-C (mmol/L)	0.885	0.674–1.157	.374
Ca (mmol/L)	0.140	0.062–0.308	<.001
WBC (10^9/L)	1.003	0.969–1.038	.862
RDW (%)	1.146	1.009–1.296	.033
NHR			<.001
Low	Ref
High	2.026	1.347–3.049

Sex, age, hypertension (no/yes), diabetes mellitus (no/yes), NHR, ALB, ALT, aspartate aminotransferase, BUN, Cr, GLU, TC, triglyceride, LDL-C, Ca, WBC, lymphocyte, RDW, and platelet were included in the univariate logistic analysis. Variables that did not have a significant effect on outcome (p > 0.05) in the univariate analysis were not included in the multivariate logistic analysis.

Abbreviations: ALB: albumin; ALT: alanine aminotransferase; BUN: blood urea nitrogen; Cr: creatinine; GLU: glucose; TC: total cholesterol; LDL-C: low-density lipoprotein cholesterol; Ca: calcium; WBC: white blood cell; RDW: red cell distribution width; NHR: neutrophil high-density lipoprotein cholesterol ratio; OR: odds ratio; CI: confidence interval.

Figure 3. Associations of the NHR and the risk of developing moderate or severe acute biliary pancreatitis using restricted cubic spline.

Data availability statement

The data presented in this study are available on request from the corresponding author, upon reasonable request.