The role of neutrophil/lymphocyte and platete/ lymphocyte rates in the evaluation of acute pancreatitis severity

ABSTRACT INTRODUCTION AND OBJECTIVES: Acute pancreatitis is an inflammatory disease of the pancreatic parenchyma. Despite advances in medicine it is a major source of morbidity and mortality. Whether its clinic is variable, the pathogenesis has not been understood thoroughly though its etiology has been known. Today there is presently no spesific biochemical parameters which can be used in diagnosis and determining the severity. In this study we aim at demonstrating whether we can use neutrophil lymphocyte ratio ( NLO ) and platelet-lymphocyte ratios that is an indicator of subclinical inflammation in the patients with acute pancreatitis as a parameter in monitoring the disease severity and progression. MATERIALS AND METHOD: 200 patients diagnosed with acute pancreatitis, hospitalized and monitored in gastroenterology service, whose files had retrospectively been studied were included in the sudy. In 0 and 48 hours the hemogram, biochemistry and C-reactive protein values of the patients were recorded into statistical package program for social sciences for Windows 18,0' (SPSS 18.0 Inc). Data were analysed by calculating neutrophile lymphocyte rate and platelet lymphocyte ratios RESULTS: 200 patients complying with our criteria, 72 (36%) of whom were male, 128 ( 64% ) of those were female; 18 ( 51% ) of 35 healthy volunteers were male and 17 ( 49%) were female. No statiscally significant difference between both groups was determined in terms of gender (sex ) (p>0,05). The average age of the patients was 6017±17.19; the average age of the control group was 46.68±16.96. The average of NRL was 9,84±9,60 in the patient group but 2,00±0,86 in the control group. Whether NRL level was found high in the patient group the cut-off value was found as 2,85( Sensitivity: 86% and specifity: 81% ). Although no significant change was found in terms of the average of NRL with respect to the disease severity, the decrease in the average of NRL among the groups was found significant in 48 hours. In our study when the cut-off value for NRL parameter was selected as 2,85 the diagnosis value of the test was determined as sensisitive at the rate of 86% and specific at the rate of 88% (grafik 2) (p=0,02, R2:0,61). While the PRL average in the patient group was 0,23±0,18 it was 0,12±0,04 in the control group. Whether the PRL average was high in the patient group, the cut-off value was found to be 0,14 in the control group (sensitivity 64% and specifity %62 ). The difference only between the disease severity and the PRL average was found slight but among the groups a signficant difference was determined. The lowness in PRL average in 48 hours was not found significant. CONSEQUENCE: The significance of the NLO and PLO elevation ( highness ) has been demonstrated in the diagnosis of acute pancreatitis, other than that there have been publications in which it is reported that NLO and PLO have increased in inflammatory diseases and have had prognostic importance. However, we have found that only the change in NLO level in first 48 hours could be associated with the disease severity. In our study we would like to draw attention to NLO as a parameter that can be used, applied and accessed easily in the similar way as Atlanta Classification with this aspect. KEY WORDS: Acute pancreatitis, neutrophile / lymphocyte ratio, platelet / lymphocyte ratio, prognostic factors.