Predictive values of neutrophil-lymphocyte ratio as an early indicator for severe acute pancreatitis in the emergency department patients

Abstract

CONTEXT: Acute pancreatitis is an acute inflammatory disease presenting with a wide range of severity.AIMS: We investigated the predictive values of the neutrophil-lymphocyte ratio (NLR) as an indicator for severe acute pancreatitis in the emergency department patients.SETTINGS AND DESIGN: This retrospective study was conducted on patients with acute pancreatitis who were diagnosed in the emergency department, from January 2008 to December 2017.SUBJECTS AND METHODS: Patients were classified into either mild-to-moderate severe group or severe group according to the Revised Atlanta Classification for Acute Pancreatitis. Clinical features and laboratory blood test parameters were considered as independent variables.STATISTICAL ANALYSIS USED: Independent variables were analyzed using the Chi-square test and Mann–Whitney U-test to determine statistically significant differences between the two groups. Logistic regression analysis and receiver operating characteristic analysis were performed to evaluate the predictive values of significantly different variables.RESULTS: Of the 672 patients, 52 (7.7%) were classified into the severe group. Tachycardia, fever, prevalence of liver cirrhosis and chronic alcoholism, white blood cell count, NLR, C-reactive protein (CRP), blood urea nitrogen (BUN), creatinine, aspartate transaminase, and total bilirubin were significantly higher in the severe group. Among them, NLR (adjusted odds ratio [aOR]: 1.13; 95% confidence interval [CI]: 1.081–1.181), CRP (aOR: 1.011; 95% CI: 1.004–1.017), BUN (aOR: 1.036; 95% CI: 1.004–1.069), and creatinine (aOR: 1.703; 95% CI: 1.008–2.877) were significant in the logistic regression analysis. NLR showed relatively high sensitivity (82.7%) and specificity (70%) and showed the highest area under the curve (0.821).CONCLUSIONS: The increase in NLR was associated with severe acute pancreatitis. NLR is expected to be useful as a prognostic factor in patients with acute pancreatitis who are visiting the emergency department.