Novel markers for mortality in patients with acute pancreatitis: NLR and PLR at the 48th hour
Keywords:
Acute pancreatitis, NLR, PLR, Atlanta scoreAbstract
Aims: In recent years, simple, effective, and rapid laboratory markers have become important to predict acute pancreatitis prognosis. In this study, we aimed to demonstrate whether there was a difference in predicting AP-related mortality between current scores and indirect markers of systemic inflammation, namely, red cell distribution width (RDW), mean platelet volume (MPV), platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) obtained at the 48th hour.
Methods: We retrospectively reviewed files of AP patients admitted to Gastroenterology Department of two hospitals to include the acute phase reactant values of 667 patients obtained at the 48th hour. CRP0 indicates CRP value at presentation while CRP, RDW, MPV, NLR and PLR indicate values at the 48th hour. In all patients, Ranson score, Atlanta score, NLR and PLR values were calculated.
Results: The patients were classified into 2 groups as survivors (n=641; 96.1%) and non-survivors (n=26; 3.9%). Both NLR and PLR were found to be significantly higher in the non-survivor group (P<0.001 and P=0.02). Both NLR and PLR were weakly and positively correlated to mortality.
Conclusion: Based on our results, MPV was not correlated with mortality, while RDW was weakly and positively correlated. However, we found that NLR and PLR values obtained at the 48th hour after presentation are effective parameters in predicting mortality in AP. These easily accessible and low-cost tests may be used for closer monitoring of these patients when necessary.
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Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase. Medicine (Baltimore). 2019 Apr;98(16):e15275.
Han C, Zeng J, Lin R, Liu J, Qian W, Ding Z, et al. The utility of neutrophil to lymphocyte ratio and fluid sequestration as an early predictor of severe acute pancreatitis. Sci Rep. 2017;7:10704.
Tee YS, Fang HY, Kuo IM, Lin YS, Huang SF, Yu MC. Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis. Medicine (Baltimore). 2018;97:e9654.
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;17:675–81.
Cho SK, Jung S, Lee KJ, Kim JW. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis. BMC Gastroenterol. 2018 25;18(1):18.
Mitchell RM, Byrne MF, Baillie J. Pancreatitis. Lancet. 2003;361:1447–55.
Larvin M. Assessment of clinical severity and prognosis. In: The Pancreas, Beger HG, Warshaw AL, Buchler MW, et al (Eds), Blackwell Science, Oxford 1998. p.489.
Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Localio SA. Objective early identification of severe acute pancreatitis. The American Journal of Gastroenterology. 1974;61:443–51.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.
Fagenholz PJ, Fernández-del Castillo C, Harris NS, Pelletier AJ, Camargo CA Jr. Direct medical costs of acute pancreatitis hospitalizations in the United States. Pancreas. 2007;35:302–7.
Whitcomb DC. Clinical practice. Acute pancreatitis. The New England Journal of Medicine. 2006;354:2142–50.
Wang D, Yang J, Zhang J, Zhang S, Wang B, Wang R, et al. Red cell distribution width predicts deaths in patients with acute pancreatitis. Journal of research in medical sciences. 2015;20:424–8.
Mutinga M, Rosenbluth A, Tenner SM, Odze RR, Sica GT, Banks PA. Does mortality occur early or late in acute pancreatitis? Int J Pancreatol. 2000;28:91–5.
Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108:1400-15;1416.
Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. European Journal of Cancer. 2011;47:2633–41.
Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Review of Cardiovascular Therapy. 2013;11:55–9.
Wang Y, Fuentes HE, Attar BM, Jaiswal P, . Evaluation of the prognostic value of neutrophil to lymphocyte ratio in patients with hypertriglyceridemia-induced acute pancreatitis. Pancreatology. 2017;17:893–7.
Jeon TJ, Park JY. Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis. World J Gastroenterol. 2017;23:3883–9.
Li Y, Zhao Y, Feng L, Guo R. Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study. BMJ Open. 2017;7:e013206.
İlhan M, İlhan G, Gök AF, Bademler S, Atmaca FV, Ertekin C. Evaluation of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and red blood cell distribution width-platelet ratio as early predictor of acute pancreatitis in pregnancy. J Matern Fetal Neonatal Med. 2016;29:1476–80.
Azab B, Bhatt VR, Phookan J, Murukutla S, Kohn N, Terjanian T, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Annals of Surgical Oncology. 2012; 19: 217–24.
Kaplan M, Ates I, Oztas E, Yuksel M, Akpinar MY, Coskun O, et al. Early predictor of acute pancreatitis: PLR-NLR combination. J Med Biochem. 2018;37(1).
Başak F, Hasbahçeci M, Şişik A, Acar A, Tekesin K, Baş G, et al. Can C-reactive protein levels increase the accuracy of the Ranson score in predicting the severity and prognosis of acute pancreatitis? A prospective cohort study. Turk J Gastroenterol. 2017;28(3):207-13.
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Copyright (c) 2019 Mehmet Suat Yalçın, Serkan Yalaki
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