NEUTROPHIL‑TO‑LYMPHOCYTE RATIO AS AN INFLAMMATORY MARKER IN PATIENTS WITH ACUTE PANCREATITIS: A PROSPECTIVE STUDY FROM A TERTIARY CARE CENTRE IN CENTRAL INDIA.
Main Article Content
Keywords
acute pancreatitis; neutrophil‑to‑lymphocyte ratio; severity.
Abstract
Background: Early prediction of severity in acute pancreatitis (AP) guides triage, monitoring and resource allocation, especially in resource‑limited settings. Neutrophil‑to‑lymphocyte ratio (NLR) is an inexpensive inflammatory marker that may aid early risk stratification.
Methods: This prospective observational study included 100 adult patients with a first episode of AP admitted to Index Medical College, Indore, from January 2021 to December 2021. Severity was classified according to the revised Atlanta criteria. Admission NLR was calculated from complete blood counts. Patients were grouped as mild versus moderately severe/severe AP. Associations of NLR with severity, ICU admission, local complications, length of stay and in‑hospital mortality were assessed. Receiver operating characteristic (ROC) analysis evaluated the diagnostic performance of NLR for predicting moderately severe/severe AP.
Results: Mean age was 42.5 ± 13.2 years; 58% were male. Gallstones (46%) and alcohol (32%) were the commonest etiologies. Mild AP occurred in 68%, and moderately severe/severe AP in 32%. Mean admission NLR was 4.3 ± 2.1 in mild AP and 9.5 ± 3.9 in moderately severe/severe AP (p<0.001). Patients with higher NLR had significantly greater ICU admission (43.8% vs 5.9%), local complications (56.3% vs 8.8%), longer hospital stay (11.5 ± 4.6 vs 5.9 ± 2.3 days) and mortality (18.8% vs 0%; all p<0.01). ROC analysis showed an area under the curve of 0.84; an NLR cut‑off of 5.0 predicted moderately severe/severe AP with 84.4% sensitivity and 79.4% specificity.
Conclusion: Admission NLR was significantly associated with severity and adverse short‑term outcomes in acute pancreatitis. As a simple, low‑cost parameter, NLR may serve as a useful adjunctive inflammatory marker for early risk stratification in AP in tertiary centres in India.
References
2. Khanna AK, Meher S, Prakash S, Tiwary SK, Singh U, Srivastava A, et al. Neutrophil-to-lymphocyte ratio as an early predictive marker for severity of acute pancreatitis. J Clin Diagn Res. 2021;15(11):1-6.
3. Suppiah A, Malde D, Arab T, Hamed M, Allgar V, Smith AM, et al. Prognostic value of neutrophil-lymphocyte and platelet-lymphocyte ratios in acute pancreatitis: a systematic review. Pancreatology. 2017;17(4):475-82.
4. Guo Q, Li A, Xia Q, Liu X, Tian B, Mai G, et al. The BISAP score, neutrophil-lymphocyte ratio, C-reactive protein, or blood urea nitrogen: which marker best predicts the outcome of acute pancreatitis? Medicine (Baltimore). 2015;94(7):e568.
5. Zahorec R. Ratio of neutrophil to lymphocyte counts - rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.
6. Azab B, Jaglall N, Atallah JP, Lamet A, Raja-Surya V, Farah B, et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology. 2011;11(4):445-52.
7. Jeon TJ, Park JY, Lee SH, Song TJ, Lee SS, Lee HS, et al. Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis. World J Gastroenterol. 2017;23(21):3883-9.
8. Dutta AK, Goel A, Sharma PK, Agarwal R, Bhatt SP, Singh N, et al. Neutrophil-to-lymphocyte ratio in acute pancreatitis as an early predictor of severity and outcome. Int Surg J. 2018;5(11):3545-8.
9. Yilmaz EM, Sevinc MM, Yakan S, Baltalarli A. The prognostic value of neutrophil-lymphocyte ratio in acute pancreatitis. Ulus Travma Acil Cerrahi Derg. 2014;20(5):338-42.
10. Afroz N, Singh SK, Nag HH, Bhasin DK. Inflammatory markers as predictors of severe acute pancreatitis: a cohort study. Pancreas. 2018;47(7):871-6.
11. Singh VK, Wu BU, Bollen TL, Repas K, Maurer R, Mortele KJ, et al. Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clin Gastroenterol Hepatol. 2009;7(11):1247-51.
12. Papachristou GI, Muddana V, Yadav D, O'Connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010;105(2):435-41.
13. Azab B, Torbey E, Hatoum H, Singh J, Khoueiry G, Bachir R, et al. Usefulness of neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol. 2010;106(4):470-6.
14. Biberci Keskin E, Arici S, Gungor A, et al. Diagnostic value of neutrophil-to-lymphocyte ratio for predicting mortality in acute pancreatitis. Turk J Gastroenterol. 2020;31(4):330-6.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Srajit Singh
Junior Resident, Department of General Medicine, Index Medical College Hospital and Research Center, Indore.
Badri Vishal Singh
Junior Resident, Department of General Medicine, Index Medical College Hospital and Research Center, Indore.
Sudhir Mourya
Professor and Head of Department, Department of General Medicine, Index Medical College Hospital and Research center, Indore
