Study on neutrophil-lymphocyte ratio (NLR) as a prognostic marker in acute pancreatitis

Supriyaa BB; N Bhakthavatchalam; Manoj Kumar; Vishnu Hayagreev

Study on neutrophil-lymphocyte ratio (NLR) as a prognostic marker in acute pancreatitis

Authors
Supriyaa BB, N Bhakthavatchalam, Manoj Kumar, Vishnu Hayagreev

Abstract
Acute pancreatitis is an inflammatory disease of the pancreas. The etiology and pathogenesis of acute pancreatitis have been intensively investigated for centuries worldwide. It can be initiated by several factors, including gallstones, alcohol, trauma, infections and hereditary factors. About 75% of pancreatitis is caused by gallstones or alcohol. Acute pancreatitis (AP) is usually a self-limiting process; however, 25 % of patients present with or subsequently develop a severe form of the disease that is associated with a mortality of up to 50 %. The neutrophil–lymphocyte ratio (NLR) is a measure of the divergence of these two WCC (white cell count) components (lymphocytes and neutrophils), which may be more accurate than the total WCC or individual neutrophil/lymphocyte counts in predicting poor outcome in patients with acute pancreatitis. The reported annual incidence is 35-40 per lakh population worldwide. The incidence of acute pancreatitis in India and in the West has increased by 28% over the past decade. The WBC count is correlated with poor prognosis as a compositional element of Ranson’s criteria, Glasgow score, Acute Physiology and Chronic Health Evaluation-II (APACHE-II), and Bedside Index of Severity in Acute Pancreatitis (BISAP), which are the prognostic scoring systems of acute pancreatitis. The objective of the study is to investigate the validity of NLR in predicting outcome, and to determine an optimal cut-off value that would allow division of patients into mild (MAP) and severe acute pancreatitis (SAP) groups based on NLRs within the first 48h of hospitalization.

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