Immature granulocytes: A novel biomarker of acute respiratory distress syndrome in patients with acute pancreatitis

Purpose: To investigate the relationship between immature granulocyte percentage (IG%) and acute respiratory distress syndrome (ARDS) in patients with acute pancreatitis (AP). Materials and methods: A cohort of 2289 patients with AP was screened; 1933 were enrolled in this prospective multicenter study. Blood samples for IG% analysis were collected on admission and processed using a hematology analyzer. Demographic, radiological, and clinical laboratory data were prospectively collected and reviewed retrospectively. Results: Increased IG% reflected significant upward tendency of ARDS incidence and severity. Multivariable logistic regression revealed that Acute Physiology and Chronic Health Evaluation (APACHE) II, CT severity index, C-reactive protein, white blood cells, granulocytes, lymphocytes, and IG% (OR 1.297 [95% CI 1.230-1.368]) were independent factors predicting ARDS onset in patients with AP. Receiver operating characteristic curve analysis revealed that area under the curve for APACHE II and IG% were 0.837 (95% CI 0.798-0.876) and 0.821 (95% CI 0.794-0.849), respectively. The combination of APACHE II score and IG% demonstrated excellent predictive power for ARDS incidence. Conclusions: IG% is a new type of biomarker for ARDS in patients with AP. which may promote timely and efficient identification of individuals at high risk for ARDS in the early stages of disease. (C) 2018 Elsevier Inc. All rights reserved.