DataSheet_1_Association Between the Neutrophil-To-Lymphocyte Ratio and Diabetes Secondary to Exocrine Pancreatic Disorders.xlsx

BackgroundDiabetes mellitus among patients with exocrine pancreatic disorders is commonly known to be associated with chronic inflammation, including chronic pancreatitis and pancreatic ductal adenocarcinoma (PDAC). The neutrophil-to-lymphocyte ratio (NLR) is a novel marker that indicates the presence of various chronic inflammatory diseases, including type 2 diabetes (T2DM). However, no studies have examined the relationship between the NLR value and diabetes secondary to exocrine pancreatic disorders.AimTo determine whether the NLR value is associated with diabetes secondary to exocrine pancreatic disorders.MethodsThe medical data of subjects with confirmed pancreatic disease who were admitted to the Department of Pancreatic Surgery of our institution from August 2017 to October 2021 were obtained from the database and retrospectively analyzed. Anthropometric measures, laboratory data, including HbA1c, fasting insulin, and fasting C-peptide levels and the inflammatory index (white blood cell count, NLR, platelet-to-lymphocyte ration, monocyte-to-lymphocyte ratio) were recorded. The NLR is the ratio of neutrophils to lymphocytes. A homeostasis model (HOMA-B and HOMA-IR) was used to measure beta-cell dysfunction and insulin resistance.ResultsThe NLR values of the diabetes secondary to exocrine pancreatic disorders group were significantly higher than those of the nondiabetic group (P=0.001). In multivariate logistic regression, after adjusting for covariates, high NLR values were found to be an independent risk factor for diabetes secondary to exocrine pancreatic disorders (OR: 1.37, 95% CI: 1.138-1.649, P=0.001). According to Spearman correlation analysis, the NLR was significantly correlated with fasting plasma glucose levels (PConclusionThe NLR inflammation marker was significantly higher in subjects with diabetes secondary to exocrine pancreatic disorders and was associated with insulin resistance. NLR values may be reliable predictive markers for diabetes among patients with exocrine pancreatic disorders.</p

Characteristics of patients with adenocarcinoma of pancreatic neck.

Characteristics of patients with adenocarcinoma of pancreatic neck.</p

Kaplan-Meier survival analysis of DP, PD and TP patients with adenocarcinoma of pancreatic neck in different AJCC stages.

A: Overall survival for stage I in DP, PD, and TP group (P = 0.962). B: Overall survival for stage II in DP, PD, and TP group (P = 0.874). C: Overall survival for stage III in DP, PD, and TP group (P = 0.942). D: Cancer-specific survival for stage I in DP, PD, and TP group (P = 0.972). E: Cancer-specific survival for stage II in DP, PD, and TP group (P = 0.790). F: Cancer-specific survival for stage III in DP, PD, and TP group (P = 0.936).</p

Univariate and multivariate analysis of overall survival in patients with surgery.

Univariate and multivariate analysis of overall survival in patients with surgery.</p

Univariate and multivariate analysis of cancer-specific survival in patients with surgery.

Univariate and multivariate analysis of cancer-specific survival in patients with surgery.</p

Kaplan-Meier survival analysis of all patients with adenocarcinoma of pancreatic neck.

A: Overall survival in surgery and no surgery group (P P < 0.001).</p

Comparison of characteristics in patients with different types of surgery.

Comparison of characteristics in patients with different types of surgery.</p

Kaplan-Meier survival analysis of DP, PD and TP patients with adenocarcinoma of pancreatic neck.

A: Overall survival in DP, PD, and TP group (P = 0.924). B: Cancer-specific survival in DP, PD, and TP group (P = 0.786).</p

Table_1_Optimal glycated hemoglobin A1c value for prediabetes and diabetes in patients with pancreatic diseases.docx

BackgroundSome articles suggest that using HbA1c alone for diabetes diagnosis is inappropriate. It requires considerable researches to explore the efficacy of HbA1c for diagnosing hyperglycemia in patients with pancreatic disease.MethodsThis study analyzed 732 patients, comprising of 331 without pancreatic disease and 401 patients diagnosed with pancreatic diseases. All participants underwent the HbA1c assay and oral glucose tolerance test. Kappa coefficients were calculated to assess agreement between the HbA1c and glucose criteria. The receiver operating characteristic curve (ROC) was used to calculate the optimal HbA1c value. DeLong test was analyzed to compared the aera under curves (AUCs).ResultsThere were 203 (61.3%) patients with NGT, 78 (23.6%) with prediabetes, and 50 (15.1%) with diabetes in patients without pancreatic diseases. In patients with pancreatic disease, 106 participants were diagnosed with NGT (36.4%), 125 with prediabetes (31.2%), and 130 with diabetes (32.4%). Patients with pancreatic disease exhibited elevated levels of bilirubin, transaminase enzymes, aspartate transaminase, high density lipoprotein cholesterol and total bile acid. The sensitivity and specificity of the HbA1c (6.5%) for diagnosing pancreatic diabetes were 60.8% (95% CI 52.3, 69.3) and 92.6% (95% CI 89.5, 95.7). In prediabetes, the sensitivity and specificity of HbA1c (5.7%) is 53.2% (44.3, 62.0) and 59.6 (51.5, 67.6). The optimal HbA1c value for diagnosing diabetes was 6.0% (AUC = 0.876, 95% CI 0.839, 0.906), with the sensitivity of 83.8% and the specificity of 76.8%. The optimal HbA1c value for the diagnosis of prediabetes was 5.8% (AUC = 0.617, 95% CI: 0.556, 0.675), with the corresponding sensitivity and specificity of 48.0% and 72.6% respectively. The combined tests (HbA1c, 6.0% or FPG, 7.0mmol/L) presented the sensitivity of 85.7% (95% CI 79.1, 91.3)and the specificity of 92.6% (95% CI 87.6, 97.3) in pancreatic diabetes.ConclusionFrom our results, the recommended HbA1c by ADA criterion may not be sufficiently sensitive to diagnose hyperglycemia in pancreatic disease. The optimal value of 5.8% and 6.0% improved the accuracy for diagnosing prediabetes and diabetes and should be considered to be applied. Besides, we advocate the combination of HbA1c and FPG test for the diagnosis of diabetes in patients with pancreatic diseases.</p

Univariate and multivariate analysis of CSS in patients who underwent curative intent surgery for pancreatic cancer by stage.

Univariate and multivariate analysis of CSS in patients who underwent curative intent surgery for pancreatic cancer by stage.</p