Neutrophil to Lymphocyte Ratio As A Predictor of Endoscopic Damage in Caustic Injuries

Abstract

Objective: To assess the ingestion of caustic substances is a medical emergency and esophagogastroduodenoscopy (EGD) is helpful in diagnosis, prognostication and management. Here, we investigated the NLR of patients, to assess the correlation of neutrophil lymphocyte ratio (NLR) with degree of caustic injury and to evaluate whether NLR can predict the degree of caustic endoscopic injury. Method: This cross sectional study was carried out on 180 patients in gastroenterology department of DHQ teaching hospital, Gujranwala from 1st Jan 2021 to 31 Dec 2021. The endoscopy was performed and CBC was sent for analysis of NLR. The esophageal and stomach mucosal injury was graded by Zargar's classification and divided into low grade and high grade. Independent sample t test was used for comparison between mean NLR versus low and high grade injury. Results: Patients with high grade damage has remarkably higher values of NLR as compared to low grade. For prediction of grade of damage, ROC analysis was used and AUC (area under curve) value was 0.838 (95% CI (0.783-0.894, p<0.001) and if we take NLR cut-off value as 3.5, the sensitivity will be 96.0% and specificity 63.3%, if we take cut-off value as 4.5, the sensitivity will be 93.1% and specificity 48.1% and if we take cut-off value as 5.5, the sensitivity will be 75.2% and specificity 35.4%. Conclusion: Neutrophil to lymphocyte ratio can predict degree of gastroesophageal injury in patients with caustic ingestion.