INTRODUCTION:
Acute pancreatitis (AP) is a commonly encountered emergency where early identification of severe complicated cases is important. Inflammatory markers like lymphocyte to monocytes ratio (LMR) and Neutrophil to Lymphocytes ratio (NLR) have been utilized as a prognostic tool in various medical condition. In this study, we are evaluating the prognostic values of these markers in Acute pancreatitis and the optimal ratio of severity prediction.
METHODS:
A retrospective chart review of patients admitted to an academic center with the diagnosis of Acute pancreatitis between August 2015 to September 2018. The patients were identified using ICD-10 codes. LMR and NLR were calculated and compared between complicated AP and non-complicated AP on admission and with change through time over 48 hours. Severity defined using revised Atlanta classification. Descriptive statistics and models were calculated using SPSS software (IBM; v. 25). Epidemiological measures and their associated confidence intervals were calculated using MedCalc (v. 18).
RESULTS:
A total of 239 out of 426 patients were eligible to be included. 41 patients had a complicated AP. The LMR showed a significant difference between groups, with the non-complicated cases consistently higher than the complicated cases on admission (F = 11.34, P = 0.001), But there were no significant temporal differences (F = 1.48, P = 0.232) (Figure 1). The NLR showed a significant difference between groups, with the non-complicated cases consistently lower than the complicated cases on admission (F = 23.11, P < 0.001) and through time on day 1 and day 2 post admission (F = 3.88, P = 0.040), with significant differences notable at both post-admission days (P < 0.05; Figure 2). Cut points for potential clinical use were investigated using the bound of the 95% confidence interval separating the two groups. LMR cut-point <2 indicating a complicated case and NLR cut-point >10.5 indicating a complicated case. Overall sensitivity was low (23–69%); however, specificity was high (85–92%). Hence, these cut-points were very good at discerning non-complicated cases (Table 1).
CONCLUSION:
Our data show persistently low LMR is associated with severe AP and value <2.0 can be used clinically to predict the severity of AP on admission. It also shows elevated NLR is associated with complicated AP and prolonged ICU stay with a value >10.5 can be used to predict severe complicated AP throughout the admission.
