Accuracy of Neutrophil to Lymphocyte Ratio (NLR) as a Predictor of Severe Acute Pancreatitis Keeping Balthazar CT Scan Severity Index Score as Gold Standard

Abstract

Background: Acute pancreatitis (AP) is usually a self-limiting process. Scoring systems aim to stratify the severity of the AP, and this in turn guides management with the aim of improving outcomes. Several scoring systems are in use to predict the severity of pancreatitis but none is fool proof. Some are very tedious to perform while others require ICU setting to be monitored. Therefore this study is designed to assess whether a non-expensive and less time consuming tool like NLR ratio can be used to predict severity in patients presenting with acute pancreatitis.

Objective: To determine the accuracy of neutrophil to lymphocyte ratio (NLR) ≥ 4.7 as a predictor of acute severe pancreatitis keeping Balthazar CT severity index score (7-10) as gold standard for acute severe pancreatitis.

Setting: Surgical Unit-5, Civil Hospital, Karachi.

Duration: Six months from 30 jan 2019 to 30 july 2019

Study Design: Cross sectional study

Subject and Methods: A total of 197 patients with acute pancreatitis with an elevated serum amylase or lipase within 24-72 hours within 3 days of start of symptoms were selected in this study. On admission CBC was advised and neutrophil to lymphocyte ratio was calculated. Patients with NLR ratio greater than 4.7 were undergo CT scan abdomen with oral and IV contrast after 1 week to calculate the CT severity index score to assess severity of AP as gold standard. A proforma was used to record.

Results: - The average age was 37.96±10.98 years. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of neutrophil to lymphocyte ratio (NLR) ≥ 4.7 in prediction of acute severe pancreatitis was 86.1%, 76.8%, 68.1%, 90.6% and 80.02%.

Conclusion: Neutrophil to lymphocyte ratio (NLR) can be used as a predictor of severity of acute pancreatitis, right at the time of initial diagnosis.