Evaluation of the prognostic value of neutrophil lymphocyte ratio in patients with acute pancreatitis

Objective: In this study, the role of Neutrophil-Lymphocyte Ratio (NLR) in predicting pancreatitis severity and prognosis in patients with acute pancreatitis (AP) was investigated, and it was aimed to detect the optimal NLR value. Materials and Methods: In the study, demographic, clinical, and laboratory data of the patients who were followed up with the diagnosis of acute pancreatitis in Dokuz Eylul University Faculty of Medicine between 2013 and 2019 were retrospectively analyzed. NLR (at admission: 0. hour, 24, and 48. hours), CRP, LDH-albumin ratio (LAR) values were compared with disease severity according to Ranson and BISAP scores, mortality, organ failure, length of hospital stay, and intensive care requirement. Optimal cut-off value, sensitivity, and specificity for NLR, CRP, and LAR values were calculated by ROC curve analysis. Results: The mean NLR at the time of admission, 24th, 48th hours, respectively, was 10.59±11.30; 9.24±11.49; 7.96±8.24. According to BISAP scoring, 38 patients (16%) were evaluated as severe AP and 200 patients (84%) were evaluated as mild AP. The best parameter for predicting severe AP was detected to be 24h NLR (cut-off:8) with 79% sensitivity and 67% specificity (AUC=0.823; 95%CI: 0.760-0.886; p<0.001). The best parameter for predicting mortality and organ failure was NLR at 48 hours (cut-off: 9.7 and 6.3, respectively) (p<0.001). No statistically significant correlation was detected between the CRP value at the time of admission and the severity of acute pancreatitis and mortality. There was a statistically significant difference between the length of stay in the hospital and the need for intensive care and the 48th hour CRP value (cut-off: 126 and 213 mg/L, respectively) (p<0.001). When the LAR cut-off: value is 139.5, 88% sensitivity and 94% specificity in predicting the mortality (AUC=0.950; 95% CI: 0.898-1,000; p<0.001). There was also a statistically significant relationship between LAR and the hospital stay, organ failure, and intensive care requirement (p <0.001). Conclusion: NLR and LAR can be used as a simple, cost-effective, and easily accessible marker in the prediction of acute pancreatitis prognosis. Despite many studies, it has not yet been clarified which of the scoring system or laboratory parameters used to predict the prognosis of acute pancreatitis is more effective. Therefore, multicenter, prospective studies with more patients are needed to determine the parameters that can be used to predict the prognosis of AP. Key Words: Acute pancreatitis, neutrophil-lymphocyte ratio, LDH-albumin ratio, prognosis