Neutrophil to Lymphocyte Ratio as an Early Predictive Marker for Adverse Outcomes in Patients with Acute Pancreatitis

Introduction: Acute pancreatitis is associated with various complications leading to morbidity and mortality. In inflammation it is common that number and proportion of inflammatory cells vary. In acute pancreatitis it has been observed in various studies that Neutrophil to Lymphocyte Ratio (NLR) can predict prognosis of the disease. Hence, a prospective study was conducted with an aim to determine the clinical significance of NLR in predicting adverse outcomes in acute pancreatitis. Aim: To compare the NLR at 0 hour, 24 hours and 48 hours between mild and Severe Acute Pancreatitis (SAP) and set an optimal NLR in predicting severity of acute pancreatitis and development of organ failure in acute pancreatitis. Materials and Methods: A prospective observational study was conducted between September 2017 to August 2019 in a tertiary care teaching institute at Kasturba Medical College and Hospital, Manipal, Karnataka, India. After obtaining Institutional Ethical Committee (IEC) clearance and fulfilling the inclusion and exclusion criteria, 180 patients with age 18 years and above with acute pancreatitis were evaluated. Patient's clinical characteristics, imaging features, biochemical, pathological, microbiological and laboratory parameters were noted. Statistical analysis was done with Statistical Package for the Social Sciences (SPSS) software version 20.0. Unpaired student's t-test was used to compare the mean differences of the two groups. A p-value <0.05 was considered as statistically significant. Results: In present study, 31-40 years age group was commonly affected with acute pancreatitis. Males were predominantly affected (84%). Among 180 patients, 49 had SAP. Alcohol was the most common cause for acute pancreatitis (69.4%). Mean NLR in Mild Acute Pancreatitis (MAP) at 0, 24, 48 hours of admission to hospital were 9.38, 6.88, 5.15, respectively. In SAP, NLR were 16.27, 12.43, 9.72 at 0, 24, 48 hours, respectively. In MAP, NLR was highest on the day of admission and rapidly came down towards normal value. In SAP, NLR was highest on day 1 and remained higher for a longer duration indicating severe ongoing inflammation. Conclusion: NLR at the time of admission has an ability to differentiate between mild and SAP. Patients with NLR >10.80 should be considered as having severe pancreatitis and managed aggressively to treat any potential complications.