The relationship between advent lipase/amylase ratio and percentage of immature granulocyte and balthazar severity score in patients who applied to the emergency department with the complaint of abdominal pain and were diagnosed with acute pancreatitis

Background-aim: In order to determine the severity and prognosis of the disease in patients diagnosed with acute pancreatitis (AP), various criteria are determined, scoring and classifications are made. Despite all the scoring and studies, it can be difficult to predict particularly severe cases. In our study, we aimed to evaluate the clinical course of the patients who applied to the emergency department with the complaint of abdominal pain and were diagnosed with AP, and to evaluate whether there is a relationship between the laboratory parameters we obtained and the Balthazar Severity Score, and to catch particularly severe cases earlier. Material-method: Our research is a retrospective study and 250 patients out of 300 patients who applied to the emergency department of Manisa Celal Bayar University Hospital between January 2018 and August 2021 and were diagnosed with "Acute Pancreatitis" were found to be suitable for the study criteria and adult patients over the age of 18 were included. All parameters of the patients were recorded by scanning through the Hospital Information Management System (HIMS) patient files. Results: Of the 250 subjects included in the study, 135(54%) were women, with a mean age of 56.11±16.70 years, mean pain scores calculated according to VAS 5.71±1.515, and Balthazar Severity Scores calculated as 2.43±1.525. When the patients were examined etiologically, the number of patients diagnosed with biliary pancreatitis was 171(68.4%), and the number of patients diagnosed with alcoholic pancreatitis was 10(4%). When we look at the outcomes of the patients, 215(86%) patients were hospitalized. Of the patients with chronic disease, 56(22.4%) had diabetes and 90(36%) had hypertension. As a result of our study, according to the groupings we made according to the VAS pain score, there was no difference in pain groups between male and female patients (p=0.202). According to the Balthazar Severity Scores we calculated, 194(77.6%) patients in the mild group, 52(20.8%) patients in the moderate group, and 4(1.6%) patients in the severe group were identified. When we look at the statistical relationship between the biliary and non-biliary groups, there is a significant difference in Hgb and Htc between the two groups, and a statistically significant difference was found between the two groups in terms of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). As a result of the study, when we examined the relationship between patient outcomes and complete blood count parameters, a statistically significant difference was found between the groups who were hospitalized in the intensive care unit and those who were hospitalized and discharged in terms of IG% (p=0.006). In terms of lipase value, a statistically significant difference was found between the groups that were hospitalized, discharged from the service and hospitalized in the intensive care unit (p< 0.001). When we compared the severity groups, which we separated according to the Balthazar Severity Score, according to laboratory values, a statistically significant difference was found between the mild and moderate-severe groups in terms of complete blood count parameters such as WBC, neutrophil, lymphocyte, NLR, and PLO, as well as LDH, Lipase/Amylase ratio (p values, respectively <0.001 and 0.001). In terms of CRP, the results can be considered borderline significant (p= 0.051). When the cut-off for NLR was taken as 14.9082, 46.4% sensitivity, 85% specificity, 47.2% PPV and 84.6% NPV were found. For the lipase/amylase ratio, when the cut-off was taken as 2.2773, 69.6% sensitivity, 57.2% specificity, 26.3% PPV and 86.7% NPV were found. Results: It was observed that the majority of those with chronic diseases were hypertension and diabetes patients. It has been determined that lipase values are important parameters in service and intensive care hospitalization. According to Balthazar Severity Score, statistically significant difference was found between mild and moderate-severe groups in terms of WBC, neutrophil, lymphocyte, NLR and PLR, LDH and Lipase/Amylase ratio. The power of IG% values in determining the severity of acute pancreatitis was not found to be statistically significant. It has been seen that evaluating patients by combining laboratory findings in addition to imaging in the diagnosis of AP can guide the prognosis of AP. Keywords: Acute pancreatitis, Balthazar Severity Score, Percentage of immature granulocytes, lipase amylase ratio