Utility of Neutrophil to Lymphocyte ratio and platelet to lymphocyte ratio as early predicter of severe acute biliary pancreatitis (original) (raw)
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Diagnostic and Prognostic Value of Neutrophil Lymphocyte Ratio in Patients with Acute Pancreatitis
European Archives of Medical Research
Acute pancreatitis is an inflammatory disease of the pancreas with local and systemic complications, and high mortality and morbidity. A variety of scoring systems have been developed for the early detection of severe acute pancreatitis. However, they are not feasible enough to detect severe patients in the early period. This study aimed to investigate the relationship between neutrophil lymphocyte ratio (NLR) and etiology of acute pancreatitis, clinical presentation, early diagnosis of severe pancreatitis, length of hospital stay and complications. Methods: A total of 150 patients with acute pancreatitis and 36 age and gender matched healthy controls were included. NLR was calculated within the first 24 hours of admission to the hospital. The results were compared with disease etiology, activity indices, complications, and length of hospital stay. Results: In patients with acute pancreatitis, NLR levels (7.0±9.3) were found to be significantly higher than in the control group (1.8±0.6) (p<0.05). There was no statistically significant difference between biliary and non-biliary pancreatitis groups in terms of neutrophil, lymphocyte, NLR, CRP and sedimentation levels (p>0.05). Regarding Ranson's criteria and Modified Glasgow Prognostic score, NLR was significantly higher in patients with severe pancreatitis (p<0.05). However, there was no similar correlation with Balthazar score. Conclusion: NLR was shown to increase in patients with acute pancreatitis as well as in other inflammatory conditions. NLR may be useful as an easily applicable parameter in the early diagnosis of disease and prediction of disease activity in patients with acute pancreatitis.
Acta Facultatis Medicae Naissensis
Introduction: Neutrophil-lymphocyte ratio (NLR) is one of the laboratory biomarkers used in clinical practice to predict severity and mortality of acute pancreatitis (AP), however, there is currently insufficient information about the changes of NLR in the dynamics in relationship with other clinical and laboratory data. Aims: To assess the relationship between NLR values and other demographics, clinical and simple laboratory data in patients with acute pancreatitis. Methods: The data of two hundred twenty-nine patients with AP were analyzed. All patients were divided into two groups: the group with a positive outcome and the group with a fatal outcome. NLR was counted on the 1st, 3rd and 5th day after admission in each group. The dynamics of NLR index by groups and days, as well as its correlation with other 18 simple laboratory parameters were evaluated. Results: The level of NLR rate itself was significantly higher on the 1st, 3rd and 5th day in the group with the fatal result co...
Cukurova Medical Journal, 2016
Decreased lymphocyte count and increased neutrophil count may be associated with severe sepsis, bacteremia, and surgical stress. The neutrophil-tolymphocyte ratio (NLR) may be used to assess inflammatory conditions and surgery. We evaluated whether NLR may be useful in the differentiation between biliary and nonbiliary acute pancreatitis. Material and Methods: Data from patients aged > 18 years who were diagnosed with acute pancreatitis between January 2011 and July 2014 were evaluated retrospectively. Patients were grouped as having biliary or nonbiliary pancreatitis. The white blood cell, neutrophil, and lymphocyte counts and NLR were evaluated and compared between the 2 groups. Results: In the 225 patients with acute pancreatitis (mean age, 59±18 y; 81 male patients [36%]), most patients had biliary pancreatitis (biliary, 144 patients [64%]; nonbiliary, 81 patients [36%]). Frequency of hypertension and mean arterial pressure were lower in patients who had biliary than nonbiliary pancreatitis. The mean white blood cell, neutrophil, and platelet counts were greater in patients who had nonbiliary than biliary pancreatitis. Conclusions: Although the NLR was increased in acute pancreatitis, there were no differences in NLR between patients who had biliary or nonbiliary acute pancreatitis. Therefore, the NLR is not useful in differentiating biliary from nonbiliary acute pancreatitis. Amaç: Artmış nötrofil sayısı ile birlikte azalmış lenfosit sayısı ağır sepsis, bakteremi ve cerrahi stres ile bağlantılıdır. Beyaz kan hücrelerinin bu farklı iki kompanentinin birbirine oranıyla bulunan nötrofil-lenfosit oranı (NLR), cerrahi ve inflamasyon durumlarını değerlendirmede kullanılmaktadır. Biz bu çalışmada akut pankreatit hastalarda, biliyer ve non-biliyer pankreatitli hastaların ayrımında NLR'nin prognostik değerini araştırmayı amaçladık. Gereç ve Yöntem: Ocak 2011 ve Temmuz 2014 tarihleri arasında akut pankreatit tanısı almış 18 yaşından büyük hastalar geriye dönük olarak değerlendirmeye alınmıştır. Hastalar etyolojik olarak biliyerpankreatit ve nonbiliyerpankreatit olarak ikiye ayrıldı. Bulgular: Çalışmaya 255 akut pankreatitli hastanın yaş ortalaması 59±18 yıl olup, 81 tanesi (%36) erkekti. Etiyolojik faktörlere bakıldığında biliyer pankreatitli hasta sayısı 144 (%64) non-biliyer pankreatitli hasta sayısı 81 (%36) idi. Hastaların fizik muayene ve laboratuar bulguları, pankreatit etyolojisine göre karşılaştırıldığında Beyaz kan hücreleri ve nötrofil değerlerinin non-biliyer pankreatit grubunda anlamlı olarak yüksek olduğu görüldü. Sonuç: Bulgularımıza göre NLR akut pankreatitte yüksek bulunmasına rağmen non-biliyer ve biliyer pankreatit arasında NLR değerinde istatiksel olarak anlamlı bir değişme olmamıştır.
A Closer Look: Assessment of Acute Pancreatitis Prognosis Using Neutrophil-Lymphocyte Ratio
2021
Background/Objectives: Acute pancreatitis (AP) is a common cause of hospitalization and severe cases are usually associated with a poor prognosis. Neutrophil to lymphocyte ratio(NLR) has been pointed as an indicator of systemic inflammation in several disorders. The aim of this study was to assess whether NLR at admission is able to predict severity of AP and some associated outcomes, while trying to establish the best cutoff value for outcomes. Materials and Methods: Single-center, retrospective study, reviewing clinical data from AP patients admitted between January 2014 and December 2015. Four hundred and forty five patients were eligible for the study and NLR was calculated based on admission laboratory data. Patients were stratified according to severity, based on the Atlanta Classification, and comparative analysis was carried between groups. Results: A total of 391 patients presented with mild AP and 54 with moderate or severe AP. NLR for the severe group was significantly higher than for the mild group (13.9±13.6 versus 10.1±9.4, respectively). There were also statistical differences in NLRs between all groups of analyzed outcomes except for in-hospital mortality. The best predictive NLR value for the stratification of AP severity was 9.2. Conclusions: This study shows a significant correlation between NLR at admission and the severity of AP. Higher NLR values also predicted the development of organ failure, ICU admission and longer hospitalizations.
Evaluation of Prognostic Factors of Severity in Acute Biliary Pancreatitis
International Journal of Molecular Sciences, 2020
Acute pancreatitis (AP) is an inflammatory disorder of the pancreas that, when classified as severe, is associated with high morbidity and mortality. Promptly identifying the severity of AP is of extreme importance for improving clinical outcomes. The aim of this study was to compare the prognostic value of serological biomarkers, ratios, and multifactorial scores in patients with acute biliary pancreatitis and to identify the best predictors. In this observational and prospective study, the biomarkers, ratios and multifactorial scores were evaluated on admission and at 48 h of the symptom onset. On admission, regarding the AP severity, the white blood count (WBC) and neutrophil–lymphocyte ratio (NLR), and regarding the mortality, the WBC and the modified Marshall score (MMS) showed the best predictive values. At 48 h, regarding the AP severity, the hepcidin, NLR, systemic inflammatory response index (SIRI) and MMS and regarding the mortality, the NLR, hepcidin and the bedside index...
World journal of emergency medicine, 2015
Harmless acute pancreatitis score (HAPS), neutrophile/lymphocyte ratio and red blood cell distribution width (RDW) are used to determine the early prognosis of patients diagnosed with nontraumatic acute pancreatitis in the emergency department (ED). Patients diagnosed with acute pancreatitis (K 85.9) in the ED according to the ICD10 coding during one year were included in the study. Patients with chronic pancreatitis and those who had missing data in their files were excluded from the study. Patients who did not have computed tomography (CT) in the ED were not included in the study. Ultimately, 322 patients were included in the study. The median age of the patients was 53.1 (IQR=36-64). Of the patients, 68.1% (n=226) had etiological causes of the biliary tract. The mortality rate of these patients within the first 48 hours was 4.3% (n=14). In the logistic regression analysis performed by using Balthazar classification, HAPS score, RDW, neutrophile/lymphocyte ratio, age, diabetes mel...
Neutrophilic Lymphocytic Ratio as a Prognostic Indicator in Acute Pancreatitis
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND In India, pancreatitis seems to be more common among alcoholics. Being a developing nation, most of the affected families live in poverty. So, the hospital expenses in treatment of pancreatitis are a burden to them. Many investigations are required for calculating the severity scoring systems will increase the patient's cost. In order to predict the severity of the disease earlier, a simple scoring system is evaluated using routine blood count which will enable us to provide aggressive treatment for those progressing to severe pancreatitis and lower the morbidity and mortality. MATERIALS AND METHODS A prospective collection of data among 100 sequential patients admitted with a diagnosis of pancreatitis based on Atlanta criteria are enrolled and data collected for severity, amylase, lipase, CECT, serum creatinine, and neutrophil lymphocyte ratio, at the time of admission, 24 hours, 48 hours and analyzed using independent variable t test. RESULTS Out of 100 patients 96% were males, alcohol was the leading cause 98%, severe pancreatitis was noted in 20% mortality was 4%, NLR was progressively increasing from 12 to 15 in severe group compared to 4 to 6 in mild group the difference was significant (p value-0.004). CONCLUSION The overall mortality due to acute pancreatitis has remained 10-15% in the past 20 years. Accurate predictors of the severity of acute pancreatitis are important because they influence clinical decision making. Neutrophilic Lymphocytic Ratio (NLR) was calculated among these patients and was found to be increased in acute pancreatitis. It was significantly higher in severe pancreatitis patients than the mild pancreatitis patients. It is thus a cost effective tool. NL R is a simple indicator of the prognosis of pancreatitis which would help in providing aggressive treatment to those patients progressing to severe pancreatitis.
Internal Medicine, 2020
Background. Acute pancreatitis represents an inflammatory disease with different grades of severity, ranging from mild to severe presentation. In current practice there are a lot of biomarkers used in diagnosis and prognosis of pancreatitis. The aim of this study was to evaluate de differences between a group with acute pancreatitis and a group of healthy people regarding the neutrophil to lymphocyte ratio (NLR), thrombocyte to lymphocyte ratio (TLR), as these two could help in the evaluation of prognosis and severity of acute pancreatitis. Method. The study had two groups: group A, included 100 patients with acute pancreatitis and group B - 30 healthy people. Results. In the group A there were 65% male and 35 % female with a mean age of 58.07±15.10 years, in the group B there were 50% male and 50% female with a mean age of 48.06±15.47 years. The majority of the people included in both groups were from the urban provenience. We obtained an important difference between group A and gr...
A New Marker to Determine Prognosis of Acute Pancreatitis: PLR and NLR Combination
Journal of Medical Biochemistry, 2017
SummaryBackground: We aimed to investigate the prognostic importance of platelet-lymphocyte ratio (PLR) and neutro - phil-lymphocyte ratio(NLR) combination for patients diagnosed with acute pancreatitis and its relationship with mortality. Methods: This retrospective study was included 142 patients diagnosed with acute pancreatitis. Ranson, Atlanta and BISAP 0h, 24h and 48h scores of the patients were calculated by examining their patient files. The patients were divided into three groups as low-risk, medium-risk and high-risk patients according to their PLR and NLR levels. Results: The number of patients with acute pancreatitis complications such as necrotizing pancreatitis, acute renal failure, sepsis and cholangitis was significantly higher in the high-risk group compared to other groups. Mortality rate was found to be 90% in the high-risk group, 16% in the medium-risk group, and 1.9% in the low-risk group. The number of patients with a Ranson score of 5 and 6, a severe Atlanta s...
Southern Clinics of Istanbul Eurasia
The exact parameters that differentiate mild acute pancreatitis (AP) from moderate AP are still unclear. The primary aim of this study was to evaluate the prognostic utility of recently used inflammatory parameters in AP patients. Methods: We retrospectively collected the level of inflammatory parameters of patients who were diagnosed with AP at the onset and remission of the disease. The inflammatory parameters-mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR), neutrophil-monocyte product (NMP), and platelet-lymphocyte ratio (PLR)-were derived from the electronic patient database. The day of the presentation to the emergency department (ED) was accepted as the day of the symptom onset, and the day when the patient declared to be pain free and started to take oral nutrition was accepted as the date of remission. We also calculated the clinical utility metrics such as positive and negative likelihood ratios at this threshold. Results: A total of 217 AP patients were retrieved from the system, and the final study population consisted of 183 AP (84.3%). According to revised Atlanta classification, 142 (77.6%) patients were mild AP (MAP) and 41 (22.4%) were moderate and severe AP (MSAP-SAP). Median neutrophil and lymphocyte counts, PLR, NLR, and NMP were all significantly higher, and lymphocyte-monocyte ratio was significantly lower in MAP group. At remission, the median MPV level was significantly higher (p=0.0062), and median white blood cell (WBC) level was significantly lower (p<0.0001). The same trend was observed in MAP group for both MPV and WBC, but not present for MPV in MSAP-SAP group. Conclusion: We found that all inflammatory markers and ratios were significantly different between MAP and MSAP groups. Among those markers, NLR was the most powerful to discriminate between those groups. During AP from onset to remission, the changes in MPV had no benefit but the change in WBC was significant regardless of AP severity.