Prognosis Of Acute Pancreatitis Research Articles

Characterization of long-term prognosis in acute pancreatitis: An explorative analysis

Background/objectivesSeverity classification systems of acute pancreatitis (AP) assess inpatient morbidity and mortality without predicting outpatient course of AP. To provide appropriate outpatient care, determinants of long-term prognosis must also be identified. The aim of this study was to define clinical groups that carry long-term prognostic significance in AP. MethodsA retrospective study that included patients admitted with AP was conducted. Determinants of long-term prognosis were extracted: These included Revised Atlanta and Determinant Based Classification (RAC), Charlson Comorbidity Index (CCI), Modified CT Severity Index (MCTSI), etiology, and local complications (LCs). Seven surrogates of morbidity up to 1 year after discharge were also collected and subsequently imputed into a clustering algorithm. The algorithm was set to produce three categories and multinomial regression analysis was performed. Results281 patients were included. The incidences of morbidity endpoints were similar among the 3 RAC categories. Three clusters were identified that carried long-term prognostic significance. Each cluster was given a name to reflect prognosis. The limited AP had the best prognosis and included patients without LCs with a low co-morbidity burden. The brittle AP had a low co-morbidity burden and high MCTSI (LCs 94%). It ran a very morbid course but had excellent survival. The high-risk AP had the worst prognosis with the highest mortality rate (28%). They had a high co-morbidity burden without local complications. ConclusionCategories that carry long-term prognostic significance in AP have been developed. This study could help formulate appropriate follow-up and ultimately improve AP outcomes.

Serum thyroid hormones levels are significantly decreased in pregnant rats with acute pancreatitis

Acute pancreatitis in pregnancy (APIP), which was thought to be a rare but severe disease, with a high perinatal mortality among maternal-fetuses. Our research aimed to study and assess thyroid injury in a rat model of APIP and its possible mechanisms. The APIP model was established by retrograde injection with sodium taurocholate. Sham-operated (SO) and APIP groups were performed at 3 time-points. Histological changes in the maternal thyroid and pancreas were assessed. The activities of serum amylase, lipase and levels of FT3, FT4, MDA, TNF-α and IL-1β were detected in maternal rats, and the expression of MIF, ICAM-1 and CD68 in the maternal thyroids were determined. In this study, maternal thyroid injury as well as pancreas injury occurred in a time-dependent manner. The activities of serum amylase, lipase and levels of MDA, TNF-α and IL-1β were markedly increased in acute pancreatitis rats, the levels of serum FT3 and FT4 were obviously decreased in APIP groups, and the expressions of MIF, ICAM-1 and CD68 were significantly increased in the thyroid of the APIP group. Ultrastructural thyroid injuries were observed in the APIP group. Our research suggests that thyroid injury is involved in the rat experimental model of APIP. The degree of thyroid dysfunction is associated with APIP, which may affect the prognosis of acute pancreatitis.

Metabolic and lifestyle risk factors for acute pancreatitis in Chinese adults: A prospective cohort study of 0.5 million people.

BackgroundLittle prospective evidence exists about risk factors and prognosis of acute pancreatitis in China. We examined the associations of certain metabolic and lifestyle factors with risk of acute pancreatitis in Chinese adults.Methods and findingsThe prospective China Kadoorie Biobank (CKB) recruited 512,891 adults aged 30 to 79 years from 5 urban and 5 rural areas between 25 June 2004 and 15 July 2008. During 9.2 years of follow-up (to 1 January 2015), 1,079 cases of acute pancreatitis were recorded. Cox regression was used to estimate adjusted hazard ratios (HRs) for acute pancreatitis associated with various metabolic and lifestyle factors among all or male (for smoking and alcohol drinking) participants. Overall, the mean waist circumference (WC) was 82.1 cm (SD 9.8) cm in men and 79.0 cm (SD 9.5) cm in women, 6% had diabetes, and 6% had gallbladder disease at baseline. WC was positively associated with risk of acute pancreatitis, with an adjusted HR of 1.35 (95% CI 1.27–1.43; p < 0.001) per 1-SD-higher WC. Individuals with diabetes or gallbladder disease had HRs of 1.34 (1.07–1.69; p = 0.01) and 2.42 (2.03–2.88; p < 0.001), respectively. Physical activity was inversely associated with risk of acute pancreatitis, with each 4 metabolic equivalent of task (MET) hours per day (MET-h/day) higher physical activity associated with an adjusted HR of 0.95 (0.91–0.99; p = 0.03). Compared with those without any metabolic risk factors (i.e., obesity, diabetes, gallbladder disease, and physical inactivity), the HRs of acute pancreatitis for those with 1, 2, or ≥3 risk factors were 1.61 (1.47–1.76), 2.36 (2.01–2.78), and 3.41 (2.46–4.72), respectively (p < 0.001). Among men, heavy alcohol drinkers (≥420 g/week) had an HR of 1.52 (1.11–2.09; p = 0.04, compared with abstainers), and current regular smokers had an HR of 1.45 (1.28–1.64; p = 0.02, compared with never smokers). Following a diagnosis of acute pancreatitis, there were higher risks of pancreatic cancer (HR = 8.26 [3.42–19.98]; p < 0.001; 13 pancreatic cancer cases) and death (1.53 [1.17–2.01]; p = 0.002; 89 deaths). Other diseases of the pancreas had similar risk factor profiles and prognosis to acute pancreatitis. The main study limitations are ascertainment of pancreatitis using hospital records and residual confounding.ConclusionsIn this relatively lean Chinese population, several modifiable metabolic and lifestyle factors were associated with higher risks of acute pancreatitis, and individuals with acute pancreatitis had higher risks of pancreatic cancer and death.

Early evaluations of BISAP socre plus Obesity in predicting acute pancreatitis

Objective To explore bedside index for severity in acute pancreatitis (BISAP) score plus obesity to assess the severity and prognosis of acute pancreatitis. Methods 134 acute pancreatitis patients who visited emergency department of our hospital during March 2016 to May 2017 were enrolled in the study. The BISAP score, body mass index (BMI) and waist circumference were recorded. Mild acute pancreatitis (MAP), moderately severe acute panceatitis (MSAP), severe acute panceatitis (SAP), death toll and their proportion, the relationship between severity and the type of obesity were compared in different BISAP scores. The BISAP and BISAP+ obesity scores were used to predict the SAP and the ROC curve of death, and to assess the predictive value of BISAP combined with obesity for AP. Results With BISAP score rising, both severity and mortality increased in acute pancreatitis; Compare with non-central obesity , central obesity are more susceptible to SAP (χ2=7.551, P=0.006); AUC of BISAP score and BISAP+ obesity score for predicting SAP is 0.779 and 0.791, the sensitivity is 87.9% and 77.8% , the specificity is 55.4% and 87.1%, the positive predictive value is 39.2% and 60.6%, the negative predictive value is 93.3% and 87.1%.AUC of BISAP score and BISAP+ obesity score for predicting death is 0.882 and 0.900. Conclusions BISAP score plus obesity has a better early predictive value than BISAP sore for the severity and prognosis of acute pancreatitis. Key words: Pancreatitis; Obesity; Severity of illness index; Prognosis

Spleen and splenic vascular involvement in acute pancreatitis: an MRI study.

To investigate the spleen and splenic vascular involvement in acute pancreatitis (AP) and their correlations with the severity of AP using magnetic resonance imaging (MRI). MRI of 239 patients with AP was retrospectively reviewed to assess splenic and splenic vascular complications, and the severity of AP. The severity of AP was graded by the MRI severity index (MRSI) and the New Revised Classification of AP 2012. The intravoxel incoherent motion (IVIM) parameters (D, D*, and f) of spleen were measured. Thirty-five subjects without pancreatic and splenic disorders were enrolled as controls for IVIM parameters. Among the 239 patients with AP, splenomegaly (16.7%), splenic infarction (0.4%), splenic vein thrombosis (4.2%), phlebitis (7.5%) and arteritis (4.2%) were observed. Splenic vascular involvement was positively correlated with the severity of AP based on both the MRSI and the New Revised Classification of AP 2012 (P<0.05). In the control and AP groups, the splenic f values were (0.164±0.074) vs. (0.210±0.095) (P=0.023) respectively. In AP patients with and without splenomegaly, f = (0.240±0.091) vs. (0.203±0.095) (P<0.001). Splenic vascular involvement and splenomegaly were common in AP. The vascular involvement was associated with the severity of AP. This complication should be considered when severity and prognosis of AP are assessed. Quantitative analysis of the spleen with IVIM might be a useful imaging biomarker for splenic perfusion changes in AP, especially in those with splenomegaly.

TH1 and TH2 Cytokine Profiles as Predictors of Severity in Acute Pancreatitis.

Acute pancreatitis (AP) is severe in up to 20% of patients, with a high mortality rate. Quantification of serum TH1 and TH2 cytokines may provide objective evidence to assess the severity of AP and predict its course. One hundred seventeen patients were studied, measuring serum concentrations of interleukin (IL)1β, IL2, IL4, IL5, IL6, IL10, IL12p70, IL13, IL18, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon (IFN) γ, and tumor necrosis factor (TNF) α. Significant differences were found between patients with severe AP and those with mild or moderately severe AP in IFN-γ (P < 0.001), IL6 (P < 0.001), TNF-α (P = 0.002), GM-CSF (P < 0.001), IL4 (P = 0.002), IL1b (P = 0.017), and IL13 (P < 0.001) concentrations. Interferon-γ, IL6, and TNF-α were associated with severe AP, whereas GM-CSF, IL4, IL1b, and IL13 were associated with mild or moderately severe AP. The IL13/IFNγ ratio was significantly higher in patients with mild AP (P = 7.36 × 10). A TH1 profile was associated with severe AP and a TH2 profile with mild or moderately severe AP. We report an IL13/IFNγ ratio of potential value to predict the prognosis in AP.

New predictor of acute necrotizing pancreatitis: Red cell distribution width.

Acute pancreatitis (AP) is inflammation of the pancreas of various severity ranging from mild abdominal pain to mortality. AP may be classified as acute interstitial edematous pancreatitis (AEP) or acute necrotizing pancreatitis (ANP), according to the revised Atlanta criteria. Most of the patients with AP are AEP (75-85% of patients), while 15-25% of patients have ANP. The mortality rate is 3% in AEP and 15% in ANP. Thus, it is important to predict the severity of AP to decrease the morbidity and mortality. The aim of the study was to evaluate the relationship between red cell distribution width (RDW) and the severity of AP on admission to hospital. Patients admitted to Adana Numune Research and Educational Hospital with a diagnosis of AP through the time frame of January 2014-May 2016 were included in our study. Diagnosis of AP was made according to the revised Atlanta classification. Patients' age, sex, etiology of AP, and RDW values were recorded on admission to the hospital. A total of 180 patients were included in the study. Eighty patients (44%) were male and 100 patients were female. Mean age was 56.25 ±18.3 years (52.66 ±14.4 in males; 59.84 ±20.2 in females). There was no statistically significant difference between patients' age. The most frequently observed etiologic factor was gallstone disease followed by alcohol intake and the use of pharmaceuticals. Drug-related AP was associated with azathioprine, furosemide, and thiazide diuretics. One hundred forty-four (80%) patients had AEP and 36 (20%) patients had ANP. RDW values showed a statistically significant difference between patients with AEP and ANP (p = 0.011). The cut-off value of RDW was 16.4 and the area under curve (AUC) value was 0.591 (p = 0.0227) with a sensitivity of 29.2% and specificity of 89.83%. Red cell distribution width could be used to evaluate the prognosis of acute pancreatitis.

Significance of red blood cell distribution width and C-reactive protein/albumin levels in predicting prognosis of acute pancreatitis.

Acute pancreatitis (AP) is one of the major pathologies among gastrointestinal system diseases. The aim of this study was to determine the relationship between the red cell distribution width (RDW) value and the C-reactive protein (CRP)/ albumin ratio in patients with AP. In this retrospective study, AP cases were enrolled and divided into 2 groups according to the Ranson criteria as moderate or severe pancreatitis. The RDW and CRP/albumin values, length of hospitalization and stay in the intensive care unit (ICU), and the complications experienced were compared between these 2 groups. A total of 264 patients were included in the study. Moderate pancreatitis was detected in 204 patients (77.2%) while severe pancreatitis was seen in 60 patients (22.8%) (p=0.081). There was no statistically significant difference in the RDW value between the groups (p=0.193). The CRP/albumin values were significantly higher in the severe pancreatitis group compared with the moderate group (p<0.001). The severe AP group also had a longer period of hospital care, both overall and in the ICU (p=0.001, p=0.047). RDW was not a specific marker for predicting prognosis in AP, but the CRP/albumin ratio is an easy-to-apply, inexpensive, and reliable marker.

A New Marker to Determine Prognosis of Acute Pancreatitis: PLR and NLR Combination.

SummaryBackgroundWe aimed to investigate the prognostic importance of platelet-lymphocyte ratio (PLR) and neutro - phil-lymphocyte ratio(NLR) combination for patients diagnosed with acute pancreatitis and its relationship with mortality.MethodsThis retrospective study was included 142 patients diagnosed with acute pancreatitis. Ranson, Atlanta and BISAP 0h, 24h and 48h scores of the patients were calculated by examining their patient files. The patients were divided into three groups as low-risk, medium-risk and high-risk patients according to their PLR and NLR levels.ResultsThe number of patients with acute pancreatitis complications such as necrotizing pancreatitis, acute renal failure, sepsis and cholangitis was significantly higher in the high-risk group compared to other groups. Mortality rate was found to be 90% in the high-risk group, 16% in the medium-risk group, and 1.9% in the low-risk group. The number of patients with a Ranson score of 5 and 6, a severe Atlanta score, a BISAP 0h score of 3 and 4, a BISAP 24h and 48h score of 4 and 5 was higher in the high-risk group compared to other groups. PLR-NLR combination, Atlanta and Ranson scores, and C-reactive protein level were determined to be independent risk factors predicting mortality in stepwise regression model. PLR-NLR combination had the highest area under curve value in terms of predicting acute claspancreatitis prognosis and had a similar diagnostic discrimination with other scoring systems.ConclusionIn our study it was found that PLR-NLR combination had a similar prognostic importance with other scoring systems used to determine acute pancreatitis prognosis.

A body mass index ≥25 kg/m2 is associated with a poor prognosis in patients with acute pancreatitis: a study of Japanese patients

In Asian population, there is limited information on the relevance between obesity and poor outcomes in acute pancreatitis (AP). The objective of this study was to examine the clinical impact of obesity based on body mass index (BMI) on prognosis of AP in Japanese patients. A total of 116 patients with AP were enrolled in this study. Univariate and multivariate logistic regression analyses were performed to examine relations between BMI and patients' outcomes. Additionally, to investigate whether including obesity as a prognostic factor improved the predictive accuracy of a Japanese prognostic factor score (PF score), a receiver-operating characteristic (ROC) curve analysis of mortality was conducted. Multiple logistic regression analyses revealed that BMI =25 kg/m2 was associated with a significant higher mortality [odds ratio (OR)=15.8; 95% confidence interval (CI): 1.1-227; P=0.043]. The area under the ROC curve (AUC) for the combination of PF score and BMI =25 kg/m2 (AUC=0.881; 95% CI: 0.809-0.952) was higher than that for the PF score alone (AUC=0.820; 95% CI: 0.713-0.927) (P=0.034). The negative impact of a high BMI on the prognosis of AP was confirmed in a Japanese population. Including BMI =25 kg/m2 as an additional parameter to PF score enhanced the predictive value of the PF score for AP-related mortality.

Intestinal Fatty Acid Binding Protein and Citrulline as Markers of Gut Injury and Prognosis in Patients With Acute Pancreatitis.

Severe acute pancreatitis (AP) is associated with high mortality due to systemic inflammatory response syndrome in the early phase and secondary infection in the later phase. Concomitant intestinal ischemia often results in gut injury. We studied intestinal fatty acid binding protein (IFABP) and citrulline levels as markers of gut injury to predict prognosis in AP. Acute pancreatitis patients at admission and controls were studied. Serum IFABP was measured by enzyme-linked immunosorbent assay and plasma citrulline by high-performance liquid chromatography technique. Ultrastructural changes in duodenal biopsy were also compared between the 2 groups. The IFABP concentration was significantly higher in AP cases (n = 94) compared with controls (n = 100) (mean [standard deviation], 592.5 [753.6] vs 87.8 [67.6] pg/mL; P < 0.001) and in patients with severe AP versus mild AP (738.3 [955.3] vs 404.0 [263.3] pg/ mL, P = 0.03). Citrulline concentration was lower in AP versus controls (29.9 [33.8] vs 83.9 [60.1] μg/L, P < 0.001). We propose a model by which these biomarkers (IFABP >350 pg/mL and citrulline <18 μg/L) are able to predict poor prognosis in 33.9% of patients with AP. The gut injury was also validated via ultrastructural changes. Intestinal fatty acid binding protein is a promising prognostic marker in acute pancreatitis.

The optimal timing of enteral nutrition and its effect on the prognosis of acute pancreatitis: A propensity score matched cohort study

BackgroundEarly enteral nutrition (EN) can improve the prognosis of acute pancreatitis (AP), but the optimal initiation time is unknown. In this study, the optimal time of early EN was analyzed to disclose the application of early EN in AP. MethodsData of 104 patients with AP were prospectively collected. With secondary infection (infected pancreatic necrosis and extrapancreatic infection) as the primary outcome variable, receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off time of early EN. Propensity score matching was used to adjust for covariates. Secondary outcomes include acute gastrointestinal injury (AGI) grades, serum albumin level, and EN-related complications. ResultsThe ROC curve analysis showed that the third day after hospital admission was the best cut-off time of early EN (with the area under the curve of 0.744). After PS matching, the proportion of secondary infection in the early EN group was significantly lower than the late EN group (8.6% vs. 36.5%, P < 0.05). Regression analysis showed that early EN was a protective factor against secondary infection (OR 0.161, 95%CI 0.036–0.718, P < 0.05). The AGI grades and serum albumin levels were better improved in the early EN group (AGI F = 4.468, P < 0.05; serum albumin F = 3.794, P < 0.05).The proportion of EN-related abdominal distension in the early EN group was significantly lower (8.8% vs. 38.5%, P < 0.05). ConclusionsEarly EN initiated within three days could reduce the risk of secondary infection and improve the nutritional status of patients with acute pancreatitis, with a better tolerance.

Prognostic value of admission red blood cell distribution width in acute pancreatitis: a systematic review.

Red blood cell distribution width (RDW) has been proved to be a strong prognostic marker in various diseases such as cardiovascular diseases, renal failure, viral hepatitis etc. But its prognostic value in acute pancreatitis (AP) remains controversial. The aim of this systematic review is to determine the prognostic value of RDW in AP. PubMed, Cochrane, Google scholar, and Web of Science were searched on March 2, 2017 to identify studies that investigated the association between RDW and the prognosis of AP. The eligible studies were reviewed and summarized. In total, 2008 articles were screened. Seven studies were included in the final analysis. Five studies estimated the prognostic value of RDW using receiver operating characteristic (ROC) curve analysis, and multivariable analysis was performed in only four studies. The major design weaknesses of eligible studies are their retrospective design and some of potential confounding factors were not adjusted. Current evidence and findings support that high admission RDW can be used as a biomarker to identify the AP patients who are at high risk of mortality. However, due to the weaknesses of available studies, further well-designed studies with large sample size and various outcome endpoints are needed to rigorously evaluate the prognostic value of RDW in AP.

Is nasogastric or nasojejunal enteral feeding more appropriate in severe acute pancreatitis?

Early enteral nutrition (EN) can improve the prognosis of acute pancreatitis (AP), but the optimal initiation time is unknown. In this study, the optimal time of early EN was analyzed to disclose the application of early EN in AP.Data of 104 patients with AP were prospectively collected. With secondary infection (infected pancreatic necrosis and extrapancreatic infection) as the primary outcome variable, receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off time of early EN. Propensity score matching was used to adjust for covariates. Secondary outcomes include acute gastrointestinal injury (AGI) grades, serum albumin level, and EN-related complications.The ROC curve analysis showed that the third day after hospital admission was the best cut-off time of early EN (with the area under the curve of 0.744). After PS matching, the proportion of secondary infection in the early EN group was significantly lower than the late EN group (8.6% vs. 36.5%, P < 0.05). Regression analysis showed that early EN was a protective factor against secondary infection (OR 0.161, 95%CI 0.036–0.718, P < 0.05). The AGI grades and serum albumin levels were better improved in the early EN group (AGI F = 4.468, P < 0.05; serum albumin F = 3.794, P < 0.05).The proportion of EN-related abdominal distension in the early EN group was significantly lower (8.8% vs. 38.5%, P < 0.05).Early EN initiated within three days could reduce the risk of secondary infection and improve the nutritional status of patients with acute pancreatitis, with a better tolerance.

Effects of infective necrosis on poor prognosis in acute pancreatitis

Objective To evaluate the effects of infective necrosis (IN) on prognosis in moderately severe or severe acute pancreatitis (AP). Methods According to the revision of Atlanta classification, from January 2001 to January 2015, admitted patients with moderately severe or severe AP were retrospectively analyzed. According to whether with the presence of persistent organ failure (POF) and /or IN, the patients were divided into four groups: group one with weither IN nor POF, group two with IN but without POF, group three with POF but without IN, group four with both IN and POF. The differences in disease severity and prognosis among groups were compared. Logistic regression and Cox proportional hazard regression model were used to analyze the effect of IN on prognosis. Results A total of 375 moderately severe or severe AP patients were enrolled. There were 211, 43, 90 and 31 patients in group one, two, three and four, respectively. A total of 121 (32.3%) patients with POF, 74 (19.7%) patients with IN, and death in 63 (16.8%) patients. The mortality rate in patients with IN was 32.4%(24/74), and which was 13.0%(39/301) in patients without IN. The mortality rates of group one, two, three and four were 1.9%(4/211), 11.6%(5/43), 38.9%(35/90) and 61.3%(19/31), respectively; mortality rate was in a trend of increasing, and the difference was statistically significant (χ2=109.672, P<0.01). Both IN (OR=8.24, 95%CI 2.09 to 32.46) and POF (OR=8.31, 95% CI 2.48 to 27.87) were independent risk factors of mortality of AP patients (both P<0.01). Both IN (OR=2.04, 95%CI 1.19 to 3.48, 0.002) and POF (OR=5.25, 95%CI 2.36 to 11.65) also were independent risk factors of shortened survival time of AP patients (both P<0.01). Conclusions IN is an independent risk factor of disease severity and poor prognosis in AP. The prognosis is the worst in AP patients with both POF and IN. Key words: Acute pancreatitis; Severe acute pancreatitis; Infective necrosis; Organ failure; Mortality; Prognosis

Sa1360 - Can Mesalazine Affect the Prognosis of Acute Pancreatitis': Evidence from the Intestine

Sa1360 - Can Mesalazine Affect the Prognosis of Acute Pancreatitis': Evidence from the Intestine

Sa1363 - A Novel Characterization of Long-Term Prognosis in Acute Pancreatitis

Sa1363 - A Novel Characterization of Long-Term Prognosis in Acute Pancreatitis

Su1244 - Frequency and Prognosis of Acute Pancreatitis Associated with Fulminant or Non-Fulminant Acute Hepatitis A, A Systematic Review

Su1244 - Frequency and Prognosis of Acute Pancreatitis Associated with Fulminant or Non-Fulminant Acute Hepatitis A, A Systematic Review

English

INTRODUCTION : Acute pancreatitis is one of the important causes of acute abdomen. The aim of the study is to analyse the etiologies, the varying clinical presentations and prognosis of acute pancreatitis and to validate the clinical, biochemical and radiological signs in diagnosing acute pancreatitis. METHODS : Total of sixty patients include both male and female of adult age group admitted in the emergency ward at Tirunelveli medical college hospital with the symptoms of acute pancreatitis and evaluation confirmed the presence of the illness, between February 2015 to August 2016. Severity assessment was based on clinical, biochemical and radiological findings. RESULTS : In this study of 60 patients, most of the patients were alcoholic (90%). Abdomen pain (100%) and abdomen distension (42%) were the most common complaints. From this study, we can conclude that most of the attacks of acute pancreatitis were milder forms. In one patient the CT abdomen showed normal pancreas associated with elevated serum amylase and lipase levels. Grades A and B accounted for more than 75% of the patients. Both CT grading and Ranson’s number are correlating directly with the severity of the disease. Total mortality was 8 out of 60 patients. All had Ranson’s score of 2 and 3. CONCLUSION : Serum amylase and lipase has only role in diagnosis of acute pancreatitis. Ranson’s scoring and CT scan play a very important role in both diagnosis and assessment of severity of the disease.

English

BACKGROUND: Acute pancreatitis is a common and a highly challenging clinical condition encountered in our day to day surgical practice. Severe pancreatitis being associated with high mortality, scoring systems has been devised to assess the severity. The Neutrophil-Lymphocyte Ratio (NLR) calculated from the WBC differential count provides a rapid indication of the extent of an inflammatory process. AIM OF THE STUDY: To investigate if Neutrophil- Lmphocyte Ratio (NLR) can act as a single indicator in assessing the prognosis of acute pancreatitis. MATERIALS AND METHODS: The NLR was calculated on 100 acute pancreatitis patients on day 0, day1 and day 2 of admission. The NLR obtained was correlated with the severity of pancreatitis using Atlanta classification. RESULTS: Of the 100 patients, 20 patients had severe acute pancreatitis. The NLR values calculated in severe acute pancreatitis was significantly higher than in mild acute pancreatitis on all 3 days (Day 0- 8.2 vs. 4.4; Day 1- 9.07 vs. 5.08; Day 2- 10.89 vs. 4.52). CONCLUSION: Elevation of Neutrophil Lymphocyte Ratio (NLR) during the first 48hrs of admission is significantly associated with severe acute pancreatitis and can be used as a simple, single, cost-effective indicator in assessing severity of acute pancreatitis.