Application of D-LA and APOB/A1 combined with SIRI score in acute pancreatitis and concurrent infectious pancreatic necrosis.

To explore the clinical value of D-lactate (D-LA), apolipoprotein B/A1 ratio (APO B/A1) and systemic immune-inflammatory response index (SIRI) in acute pancreatitis (AP) progression and concurrent infectious pancreatic necrosis. This retrospective study included 116 AP patients (Jun 2021 - Dec 2024, Chongqing University Qianjiang Hospital). Patients were assigned to the model group, categorized into bedside indices for severity in acute pancreatitis (BISAP) of mild (n=57), moderate (n=31), and severe (n=28) subgroups. D-LA, APOB/A1, SIRI, and BISAP were compared. Correlations were analyzed via Pearson. Patients were also divided into an infected group (36 cases) and a non-infected group (80 cases) to compare clinical data as well as the above indices. Multivariate logistic regression identified its influencing factors. An external cohort (54 patients) validated the model via ROC and calibration curves. As the severity of AP worsens, D-LA, APO B/A1, and SIRI all increase, and D-LA, APO B/A1, and SIRI were positively correlated with BISAP scores (r=0.503, 0.563, 0.314, P<0.05). According to statistics, The infected group had older age, and higher TC, TG, serum creatinine, D-LA, APOB/A1, and SIRI than the non-infected group (all P<0.05). Multivariate logistic regression identified D-LA, APOB/A1, and SIRI as risk factors for infectious pancreatic necrosis in AP patients (all P<0.05). The combined detection of these three indicators had a higher AUC for assessing infectious pancreatic necrosis than single detection (Z=2.581, 3.669, 2.945, all P<0.05). The model group showed good predictive performance (AUC=0.859), and the external validation group confirmed consistent accuracy (AUC=0.846). D-LA, APO B/A1, SIRI correlate with AP severity and the combined model enables early assessment and personalized measures.