Early prediction value of PCT and CRP on severity of acute cholangitis and construction of nomogram model

doi:10.3877/cma.j.issn.1674-3946.2025.02.020.

Abstract

Abstract:

Objective

To explore the early prediction value of procalcitonin (PCT) and C-reactive protein (CRP) in the severity of acute cholangitis, and establish a Nomogram model.

Methods

Clinical data of 162 patients with acute cholangitis from January 2021 to June 2023 were retrospectively analyzed, and they were divided into mild group (n=67 cases) and moderate and severe group (n=95 cases) according to the severity of their disease.SPSS 21.0 statistical software was used to process the data.The independent risk factors influencing the severity of acute cholangitis were screened by multivariate Logistic regression analysis.R software “rms” package to build Nomogram model.

Results

Compared with mild group, age, history of hypertension, total bilirubin (TBIL), white blood cell (WBC), albumin (ALB), PCT and CRP in moderate to severe group were significantly increased, and ALB was significantly decreased (P＜0.05).Age, WBC, ALB,PCT and CRP were independent risk factors for acute cholangitis severity (P＜0.05).ROC curve analysis showed that the AUC of PCT and CRP in predicting the severity of acute cholangitis was 0.931, which was significantly higher than that of PCT (P＜0.001), CRP (P=0.002), age +WBC+ALB (P=0.014).The five risk factors selected by multivariate Logistic regression analysis were defined as Nomogram Model 1, and the combined Model of age,WBC and ALB was defined as Model 2.Model 1 was better at predicting the severity of acute cholangitis (AUC:0.955 vs. 0.788).

Conclusion

PCT and CRP can predict the severity of acute cholangitis in early stage.Nomogram based on PCT and CRP has high predictive efficacy and clinical benefit.

Key words: Acute Cholangitis, Procalcitonin, C-Reactive Protein, Nomograms, Forecasting

Danfeng Shen, Peng Chang, Yingchao Lu, Hongxing Xu, Qiang Gu. Early prediction value of PCT and CRP on severity of acute cholangitis and construction of nomogram model[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 192-195.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.02.020.

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2025/V19/I02/192

Figures/Tables 6

指标	轻度组（n=67）	中重度组（n=95）	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ±s）	56.5±9.6	61.2±9.2	3.110	0.002
体质量指数（kg/m²， $\overset{ˉ}{x}$ ±s）	23.4±2.9	23.7±2.7	0.517	0.606
男/女（例）	37/30	54/41	0.042	0.838
高血压病史［例（%）］	13(19.4)	32(22.7)	3.994	0.046
糖尿病史［例（%）］	7(10.5)	16(16.8)	1.319	0.251
胆道病史［例（%）］	39(58.2)	62(65.3)	0.833	0.361
平均动脉压（mmHg， $\overset{ˉ}{x}$ ±s）	91.5±3.3	90.7±3.9	1.219	0.225
TBIL（μmol/L， $\overset{ˉ}{x}$ ±s）	48.6±8.5	56.3±9.2	5.455	＜0.001
WBC（×10⁹/L， $\overset{ˉ}{x}$ ±s）	8.5±2.3	10.4±2.2	5.277	＜0.001
血小板（×10⁹/L， $\overset{ˉ}{x}$ ±s）	211.9±56.8	197.6±60.5	1.523	0.130
ALB（g/L， $\overset{ˉ}{x}$ ±s）	40.1±6.5	36.6±6.2	3.542	0.001
PCT（μg/L， $\overset{ˉ}{x}$ ±s）	3.1±2.0	6.2±2.3	8.986	＜0.001
CRP（mg/L， $\overset{ˉ}{x}$ ±s）	66.8±17.6	97.1±21.4	9.841	＜0.001
甘油三酯（mmol/L， $\overset{ˉ}{x}$ ±s）	5.3±1.3	5.5±1.5	1.266	0.207
总胆固醇（mmol/L， $\overset{ˉ}{x}$ ±s）	3.9±1.6	4.1±1.5	0.907	0.366
尿素氮（mmol/L， $\overset{ˉ}{x}$ ±s）	6.9±1.1	7.1±1.2	0.982	0.328
血肌酐（μmol/L， $\overset{ˉ}{x}$ ±s）	70.6±13.6	73.3±13.8	1.221	0.224
谷丙转氨酶（U/L， $\overset{ˉ}{x}$ ±s）	158.6±74.2	139.3±80.8	1.282	0.202
谷草转氨酶（U/L， $\overset{ˉ}{x}$ ±s）	82.8±49.4	97.4±51.7	1.896	0.060

指标	轻度组（n=67）	中重度组（n=95）	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ±s）	56.5±9.6	61.2±9.2	3.110	0.002
体质量指数（kg/m²， $\overset{ˉ}{x}$ ±s）	23.4±2.9	23.7±2.7	0.517	0.606
男/女（例）	37/30	54/41	0.042	0.838
高血压病史［例（%）］	13(19.4)	32(22.7)	3.994	0.046
糖尿病史［例（%）］	7(10.5)	16(16.8)	1.319	0.251
胆道病史［例（%）］	39(58.2)	62(65.3)	0.833	0.361
平均动脉压（mmHg， $\overset{ˉ}{x}$ ±s）	91.5±3.3	90.7±3.9	1.219	0.225
TBIL（μmol/L， $\overset{ˉ}{x}$ ±s）	48.6±8.5	56.3±9.2	5.455	＜0.001
WBC（×10⁹/L， $\overset{ˉ}{x}$ ±s）	8.5±2.3	10.4±2.2	5.277	＜0.001
血小板（×10⁹/L， $\overset{ˉ}{x}$ ±s）	211.9±56.8	197.6±60.5	1.523	0.130
ALB（g/L， $\overset{ˉ}{x}$ ±s）	40.1±6.5	36.6±6.2	3.542	0.001
PCT（μg/L， $\overset{ˉ}{x}$ ±s）	3.1±2.0	6.2±2.3	8.986	＜0.001
CRP（mg/L， $\overset{ˉ}{x}$ ±s）	66.8±17.6	97.1±21.4	9.841	＜0.001
甘油三酯（mmol/L， $\overset{ˉ}{x}$ ±s）	5.3±1.3	5.5±1.5	1.266	0.207
总胆固醇（mmol/L， $\overset{ˉ}{x}$ ±s）	3.9±1.6	4.1±1.5	0.907	0.366
尿素氮（mmol/L， $\overset{ˉ}{x}$ ±s）	6.9±1.1	7.1±1.2	0.982	0.328
血肌酐（μmol/L， $\overset{ˉ}{x}$ ±s）	70.6±13.6	73.3±13.8	1.221	0.224
谷丙转氨酶（U/L， $\overset{ˉ}{x}$ ±s）	158.6±74.2	139.3±80.8	1.282	0.202
谷草转氨酶（U/L， $\overset{ˉ}{x}$ ±s）	82.8±49.4	97.4±51.7	1.896	0.060

变量	β值	SE值	Wald值	OR值(95%CI)	P值
年龄	0.135	0.045	8.954	1.144(1.048-1.249)	0.003
高血压病史	0.954	0.758	1.582	2.595(0.587-11.466)	0.208
TBIL	0.028	0.032	0.751	1.028(0.956-1.096)	0.386
WBC	0.399	0.134	8.915	1.491(1.147-1.938)	0.003
ALB	-0.153	0.064	5.648	0.858(0.757-0.974)	0.017
PCT	0.793	0.183	18.727	2.210(1.543-3.165)	＜0.001
CRP	0.092	0.023	15.835	1.096(1.048-1.147)	＜0.001

变量	AUC	最佳截断值	Youden指数	灵敏度（%）	特异度（%）	95%CI	P值
年龄	0.638	62岁	0.302	60.00	70.15	0.559-0.712	0.002
WBC	0.717	9.4×10⁹/L	0.360	67.37	68.66	0.641-0.785	＜0.001
ALB	0.647	40.6g/L	0.255	74.74	50.75	0.568-0.720	0.001
PCT	0.844	4.5μg/L	0.560	76.84	79.10	0.779-0.896	＜0.001
CRP	0.863	82.9mg/L	0.583	74.74	83.58	0.801-0.912	＜0.001
年龄+WBC+ALB	0.788	0.545	0.445	75.79	68.66	0.717-0.848	＜0.001
PCT+CRP	0.931	0.691	0.569	67.37	89.55	0.778-0.895	＜0.001

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