The role of HAPS, neutrophil/lymphocyte and platelet/lymphocyte ratio in determining the severity of disease in patients diagnosed with acute pancreatitis in the emergency department

Introduction: Abdominal pain is a very common complaint in emergency departments. Acute pancreatitis is one of the diseases that early diagnosis and treatment are important in patients who presnet to the emergency department with abdominal pain. Studies to estimate the severity of acute pancreatitis can help identify the patients at increased risk of morbidity and mortality, thus it can assist in early triage and identifying the patients who need specific interventions suitable for intensive care units. In this study, the significance of HAPS, NLR and PLR values in determining the severity of the disease and prognosis in the early stage in patients diagnosed with acute pancreatitis in the emergency department will be investigated. Material and Method: Patients who visited the emergency department of Akdeniz University Hospital between 01.01.2019 and 01.03.2022 and whose lipase test was studied were determined. Patients diagnosed with acute pancreatitis were included in the study by examining medical records of patients whose lipase test higher than the laboratory reference value, by looking at their history and physical examination findings, laboratory and imaging results, hospitalization information and discharge summaries. Patients who required intensive care, developed necrotizing pancreatitis and died were classified as severe pancreatitis with poor prognosis. The importance of HAPS, NLO and PLO values in determining the patients who will develop severe pancreatitis was studied and SPSS program was used for statistical analysis. Results: 347 patients with a definitive diagnosis of acute pancreatitis included in the study, 163 (47%) were male and 184 (53%) were female. The mean age was 52.6±16.2 and the median was was calculated as 54 (min:17-max:95). 78 (22.5%) of the patients were discharged and 269 (57.6%) patients were hospitalized. Severe pancreatitis with poor prognostic outcomes (death, necrotizing pancreatitis, need for intensive care) developed in 8 (2.3%) of the hospitalized patients. The sensitivity of HAPS in identifying severe pancreatitis patients was 87.5%, its specificity was 53.1%, and its negative predictive value was 99.4%. ROC analysis for NLO revealed AUC of 0.785 (95% CI; 0.62-0.94). For the threshold value NLR = 11 calculated from the curve, the sensitivity was 75%, the selectivity was 84.3%, and the NPV was 99.3%. For the threshold value of PLO = 220 calculated from the curve, the sensitivity was 87.5%, the selectivity was 72.3%, and the NPV was 99.6%. A significant correlation was found between NLR, PLR, high age and the development of severe pancreatitis (p=0.006, p=0.008, p=0.005). Conclusion: Based on the results of the study, it was determined that high NLR and PLR values were significantly related in predicting the development of severe acute pancreatitis. Similarly, high age was found to be associated with severe disease. HAPS was found to have a significant relationship in predicting the development of non-severe acute pancreatitis. As a result of our study, it has been shown that these parameters can be used to correctly select patients who do not need intensive care, are non-fatal, can be discharged with a low number of hospitalizations in the service, and can even be followed up at home. Key Words: Acute pancreatitis, NLR, PLR, HAPS, Age