Association of D-dimer/Lymphocyte ratio with severity in acute pancreatitis: a cross-sectional study

Abstract

The D-dimer/lymphocyte ratio (DLR) reflects coagulation activation and immune status, but its association with the severity of acute pancreatitis (AP) remains unclear. This study aimed to investigate the relationship between DLR and AP severity. This cross-sectional study included 285 adult patients with AP admitted to the Department of Gastroenterology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, China, between February 2024 and April 2025. Disease severity was classified according to the computed tomography severity index as mild acute pancreatitis (MAP) or moderately severe/severe acute pancreatitis (MSAP/SAP). DLR was calculated as D-dimer divided by lymphocyte count and was log-transformed as LogDLR. Logistic regression and restricted cubic spline (RCS) analyses were used to assess the association between LogDLR and MSAP/SAP. Receiver operating characteristic (ROC) analysis compared the discriminatory performance of LogDLR, NLR, PLR, and CLR; Optimal cut-off values were determined using the maximum Youden index. Among the 285 patients, 202 were classified as MAP and 83 as MSAP/SAP. As LogDLR increased, age, C-reactive protein, D-dimer, and length of hospital stay showed increasing trends, whereas lymphocyte count decreased. Univariate analysis showed that LogDLR was positively associated with AP severity (OR = 2,81, 95%CI: 1.70–4.66, P < 0.001). This association remained significant after adjustment for sex, age, body mass index, hypertension, and diabetes (OR = 3.33, 95%CI: 1.90–5.81, P < 0.001), and further adjustment for, triglycerides, total cholesterol, and low-density lipoprotein cholesterol (OR = 3.45, 95%CI: 1.95–6.07, P < 0.001). Compared with the lowest quartile, the risk of MSAP/SAP in patients classified within group Q4 was remained significantly elevated (model 1: Q4: OR = 4.21, 95% CI: 1.94–9.12, P < 0.001, model 2: Q4: OR = 5.34, 95% CI: 2.31–12.35, P < 0.001, model 3: Q4: OR = 5.57, 95% CI: 2.36–13.15, P < 0.001); all P < 0.001). The RCS analysis showed an overall association ( P < 0.001) without statistically significant nonlinearity ( P = 0.065). LogDLR showed the highest discriminatory ability for MSAP/SAP, with an AUC of 0.68 (95% CI: 0.61–0.75). Higher DLR was independently associated with greater odds of MSAP/SAP. Although its discriminatory performance was modest, DLR may complement established severity assessments as a readily available marker for early risk stratification in patients with AP.