The Neutrophil to Lymphocyte Ratio (Nlr) as an Early Predictor of Severity and Outcomes in Acute Pancreatitis

Abstract

Background: Acute pancreatitis is still one of the common causes of emergency hospital admissions in India. Accurate predictors of the severity are important because they influence intervention and management. Many indices of severity including Ranson's, Modified Glasgow, and APACHE II scores have been described. These multiple factors scoring systems are difficult to use, cumbersome, and hence not feasible in the rural Indian setup. This study was done to determine the severity at an early stage using the Neutrophil to Lymphocyte ratio (NLR). Also, to demonstrate the usefulness of NLR in predicting the length of hospital stay, ICU admission and to predict manifestations of adverse outcomes including organ failure. Methodology: We retrospectively analyzed 107 patients diagnosed with acute pancreatitis. Patients were grouped according to the severity and occurrence of organ failure. A comparative analysis was performed to compare the NLR between groups. Results: The severe acute pancreatitis group had a significantly higher median NLR than the mild and moderate groups (p <0.001). NLR significantly correlated to the length of hospital stay and ICU admission among the patients. NLR at admission correlated to modified Marshall's score in predicting organ failure. The ROC curve analyses showed the optimal cut-off values of NLR >8.5 at admission correlated with adverse outcomes. Conclusion: NLR can be used as a predictor to identify patients with high-risk progression to develop severe acute pancreatitis in the early stage, including organ failure. NLR can be used as a tool to refer at-risk patients to tertiary centers needing ICU admission.