Neutrophil-lymphocyte and hematocrit scoring in acute pancreatitis as an early predictor of severity and outcome
Keywords:Acute pancreatitis, Neutrophil to lymphocyte ratio, Neutrophil-lymphocyte and hematocrit score, Severe acute pancreatitis
Background: The management of acute pancreatitis (AP) is determined by an accurate assessment of severity of disease. Numerous severity indicators have been described till date, most of which require reassessment after admission and resuscitation. Authors propose a novel indicator, the neutrophil-lymphocyte and hematocrit (NLH) scoring as a predictor of acute pancreatitis at the initial time of diagnosis. NLH may have a role in predicting the length of hospital stay and intensive care unit admission and also to predict adverse manifestations of severe acute pancreatitis (SAP).
Methods: A retrospective analysis of 107 patients done who diagnosed with acute pancreatitis based on Atlanta 2012 definitions, who were admitted and treated between August 2018 and November 2019. NLH score calculated by adding NLR (neutrophil lymphocyte ratio) and Ht (hematocrit) i.e., NLH=NLR+Ht. NLH was also compared with APACHE II score as a standard predictor of prognosis in acute pancreatitis.
Results: Median NLH score among the severe group is significantly higher compared to mild and moderate group. NLH score significantly correlated with length of hospital stay and also had a statistically significant correlation with ICU stay. NLH scoring is comparable with APACHE II scoring system in predicting prognosis in acute pancreatitis.
Conclusions: NLH score can be used as a predictor of severity of acute pancreatitis, right at the time of initial diagnosis. Further it may predict adverse outcomes, need for ICU care as well as the length of hospital stay. NLH score can be used as a tool to refer at risk patients to tertiary center needing ICU admission.
Zhang Y, Wu W, Dong L, Yang C, Fan P, Wu H. Neutrophil to lymphocyte ratio predicts persistent organ failure and in-hospital mortality in an Asian Chinese population of acute pancreatitis. Med. 2016;95(37):e4746.
Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet. 2008;371:143-52.
Ponette J, Wilmer A. Update on the management of acute severe pancreatitis. Acta Clin Belg. 2001;56:135-45.
Pavlidis TE, Pavlidis ET, Sakantamis AK. Advances in prognostic factors in acute pancreatitis: a mini-review. Hepatobiliary Pancreat Dis Int. 2010;9(5):482-6.
Suppiah A, Malde D, Arab T, Hamed M, Allgar V, Smith AM, et al. The prognostic value of the neutrophil-lymphocyte ratio (NLR) in acute pancreatitis: identification of an optimal NLR. J Gastrointest Surg. 2013;17(4):675-81.
Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson’s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010;105:435-41.
Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med. 2006;354:2142-50.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102-11.
Petrov MS, Shanbhag S, Chakraborty M, Phillips AR, Windsor JA. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterol. 2010;139:813-20.
Azab B, Jaglall N, Atallah JP, Lamet A, Raja-Surya V, Farah B. Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatol. 2011;11:445-52.
Park JY, Jeon TJ, Ha TH, Hwang JT, Sinn DH, Oh TH, et al. Bedside index for severity in acute pancreatitis: comparison with other scoring systems in predicting severity and organ failure. Hepatobiliary Pancreat Dis Int. 2013;12:645-50.
Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102:5‐14.