Frontal QRS-T angle and inflammatory indices as predictors of pancreatic necrosis in acute pancreatitis: A retrospective cohort study

Pancreatic necrosis represents one of the most severe complications of acute pancreatitis (AP) and is linked to heightened risks of morbidity and mortality. Early recognition of this condition through simple and widely available biomarkers is particularly important in emergency departments, where immediate access to advanced imaging modalities may be limited. This study evaluated the diagnostic utility of the frontal QRS-T angle along with several inflammatory markers calculated from routine blood tests, including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), for predicting the presence of pancreatic necrosis. This retrospective study included adult patients diagnosed with AP in the emergency department between September 2022 and September 2024. Exclusion criteria were applied, and 227 patients were analyzed. Electrocardiographic (ECG) and laboratory data obtained upon admission were compared between patients with and without radiologically confirmed necrosis. Receiver operating characteristic curve analysis and logistic regression models were used to determine the diagnostic performance and independent predictors of necrosis. Pancreatic necrosis was present in 50 patients (22.0%). The frontal QRS-T angle (F-QRS-T) was significantly higher in patients with necrosis (113.64 ± 45.41° vs 54.63 ± 36.27°, P < .001) and showed the strongest predictive performance (area under the curve (AUC) = 0.838, 95% confidence interval (CI): 0.784-0.884), with 58.0% sensitivity and 92.7% specificity at a cutoff of 105°. Inflammatory indices SII (AUC = 0.703), SIRI (AUC = 0.658), and AISI (AUC = 0.809) were also significantly elevated in the necrosis group. In multivariate analysis, the F-QRS-T remained the most significant independent predictor of necrosis (odds ratio = 1.039, 95% CI: 1.024-1.055, P < .001), along with C-reactive protein, SII, SIRI, and AISI. The F-QRS-T and inflammatory indices are promising early markers for predicting pancreatic necrosis in AP. Their utility is particularly valuable in peripheral or resource-limited settings where computed tomography imaging is not readily available or contrast use is contraindicated. Integration of these parameters into a standardized necrosis risk score may aid in timely intervention and improve patient outcomes. Further prospective research is required to confirm and strengthen these observations.