Elsevier

Pancreatology

Volume 11, Issue 4, August 2011, Pages 445-452
Pancreatology

Neutrophil-Lymphocyte Ratio as a Predictor of Adverse outcomes of Acute Pancreatitis

https://doi.org/10.1159/000331494Get rights and content

Abstract

Background: Most acute pancreatitis risk scoring systems use total white blood cell counts (WBC) as one of the riskfactors. Thevalue of the neutrophil-lymphocyte ratio (NLR) to predict the severity of acute pancreatitis has not been previously evaluated. Methods. This observational study included 283 patients admitted to a tertiarycenter between 2004 and 2007. The patients were arranged into tertiles according to NLR and WBC values. The primary outcomes were intensive care unit (ICU) admission and length of stay (LOS) in the hospital. Results:According to NLR tertiles, patients in the 3rd tertile (NLR ≥7.6) had significantly more ICU admissions (17 vs. 2.2%, p < 0.0001) and longer average LOS (6.2 vs. 4.2 days, p < 0.002) compared with those in the 1st tertile (NLR <3.6). According to WBC tertiles, patients in the 3rd tertile had more ICU admissions (12.6vs.6.2%, p=0.12) and a longer average LOS (5.8vs. 4.4 days, p = 0.059) compared to patients in the 1st WBC tertile, but thisdid not reach statistical significance. In the multivariate model including NLR, WBC and other predictors, only NLR tertiles (p < 0.0262) and modified early warning scores (p<0.0025) were significant predictors of ICU admission. Likewise, in the multivariate model of LOS, only NLR and glucose level were significant predictors of longer LOS (p<0.0161 and p < 0.0053, respectively). Conclusion: NLR is superior to total WBC in predicting adverse outcomes of acute pancreatitis. According to our data, we suggest using the NLR cutoff value of >4.7 as a simple indicator of severity in patients presenting with acute pancreatitis.

References (37)

  • UU Tamhane et al.

    Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome

    Am J Cardiol

    (2008)
  • Y Takeyama et al.

    Peripheral lymphocyte reduction in severe acute pancreatitis is caused by apoptotic cell death

    J Gastrointesi Surg

    (2000)
  • JP Neoptolemos et al.

    Acute pancreatitis the substantial human and financial costs

    Gut

    (1998)
  • SSYD Vege et al.

    pancreatitis

  • PG Lankisch et al.

    Undetected fatal acute pancreatitis why is the disease so frequently overlooked?

    Am J Gastroenterol

    (1991)
  • EJ Balthazar et al.

    Acute pancreatitis: value of CT in establishing prognosis

    Radiology

    (1990)
  • C Chatzicostas et al.

    Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II and III scoring systems in predicting acute pancreatfis outcome

    J Cun Gastroenterol

    (2003)
  • SL Blarney et al.

    Prognostic factors in acute pancreatifis

    Gut

    (1984)
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