Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis

doi:10.3748/wjg.v23.i21.3883

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Jun 7, 2017; 23(21): 3883-3889
Published online Jun 7, 2017. doi: 10.3748/wjg.v23.i21.3883

Table 1 Patient demographics, pancreatitis etiology and laboratory findings comparing mild and severe acute pancreatitis at day 0

	All (n = 490)	MAP (n = 420)	SAP (n = 70)	P value
Age (yr)	52.36 ± 16.98	52.34 ± 17.15	52.46 ± 16.01	0.958
Sex: male (%)	352 (71.8)	297 (70.7)	55 (78.6)	0.176
Etiology, n (%)				0.839
Gallstones	136 (27.8)	119 (28.3)	17 (24.3)
Alcohol	250 (51.0)	212 (50.5)	38 (54.3)
Hypertriglyceridemia	8 (1.6)	6 (1.4)	2 (2.9)
Idiopathic	84 (17.1)	73 (17.4)	11 (15.7)
Cancer	12 (2.4)	10 (2.4)	2 (2.9)
Laboratory (at admission)
WBC (× 10⁹/L)	11.90 ± 5.61	11.80 ± 5.68	12.53 ± 5.14	0.315
CRP (mg/dL)	6.55 ± 8.10	5.90 ± 7.32	10.32 ± 11.03	0.001
Hct (%)	41.51 ± 5.78	41.61 ± 5.81	40.89 ± 5.52	0.330
BUN (mg/dL)	14.91 ± 9.51	14.76 ± 9.63	15.84 ± 8.76	0.382
Calcium (mg/dL)	8.50 ± 0.85	8.60 ± 0.78	7.90 ± 0.99	0.001
Albumin (g/dL)	3.90 ± 0.63	3.94 ± 0.62	3.71 ± 0.63	0.006
Glucose (mg/dL)	155.25 ± 98.25	153.45 ± 100.41	165.54 ± 84.76	0.343
LDH (U)	523.36 ± 480.75	518.47 ± 492.08	553.15 ± 406.77	0.585
BMI (kg/m²)	23.85 ± 4.12	23.93 ± 4.19	23.42 ± 3.72	0.368
Hospital stay (d)	9.81 ± 7.15	9.21 ± 6.34	13.36 ± 10.11	0.001

Data expressed as mean ± SD. MAP: Mild acute pancreatitis; SAP: Severe acute pancreatitis; WBC: White blood cell; CRP: C-reactive protein; Hct: Hematocrit; BUN: Blood urea nitrogen; LDH: Lactate dehydrogenase; BMI: Body mass index, P value < 0.05.

Table 2 Sequential changes in the neutorphil-lymphocyte ratio in mild acute pancreatitis and severe acute pancreatitis groups

	All (n = 490)	MAP (n = 420)	SAP (n = 70)	P value
NLR 0	4.95 (6.15)	4.74 (5.79)	6.14 (6.64)	0.010
NLR 1	4.64 (6.28)	4.47 (5.82)	6.71 (7.71)	0.002
NLR 2	3.39 (4.50)	3.20 (4.15)	5.70 (6.75)	0.001
NLR 3	2.45 (3.47)	3.30 (3.26)	4.00 (5.90)	0.001

NLR 0, Neutorphil-lymphocyte ratio at admission; neutrophil-lymphocyte ratio (NLR) 1, on day 1; NLR 2, on day 2; NLR 3, on day 3; P value < 0.05. Value expressed as median NLR (IQR). MAP: Mild acute pancreatitis; SAP: Severe acute pancreatitis; IQR: Interquartile range.

Table 3 Sequential changes in the neutorphil-lymphocyte ratio of acute pancreatitis between with and without organ failure groups

	All (n = 490)	Organ failure (-)(n = 459)	Organ failure (+)(n = 31)	P value
NLR 0	4.95 (6.15)	4.85 (6.09)	7.09 (7.87)	0.03
NLR 1	4.64 (6.28)	4.49 (6.08)	6.72 (12.37)	0.003
NLR 2	3.39 (4.50)	3.35 (4.29)	6.27 (12.19)	0.002
NLR 3	2.45 (3.47)	2.34 (3.35)	6.24 (8.37)	0.001

Value expressed as median NLR (IQR); IQR: Interquartile range; NLR 0, neutrophil-lymphocyte ratio at admission; NLR 1, on day 1; NLR 2, on day 2; NLR 3, on day 3; P value < 0.05. NLR: Neutrophil-lymphocyte ratio.

Table 4 Area under curve (95%CI) value for predicting disease severity, development of organ failure, necrosis, local complications, ICU admission and mortality

	Severity	Organ failure	Necrosis	Local Cx	ICU adm	Mortality
NLR 0	0.59^a (0.52-0.66)	0.62^a (0.51-0.72)	0.52 (0.44-0.60)	0.54 (0.48-0.60)	0.58 (0.47-0.70)	0.44 (0.21-0.67)
NLR 1	0.62^a (0.55-0.69)	0.66^a (0.55-0.77)	0.60^a (0.52-0.68)	0.57 (0.51-0.63)	0.73^a (0.63-0.83)	0.62 (0.38-0.85)
NLR 2	0.62^a (0.55-0.70)	0.66^a (0.55-0.78)	0.61^a (0.53-0.69)	0.59^a (0.53-0.66)	0.74^a (0.64-0.84)	0.60 (0.30-0.85)
NLR 3	0.62^a (0.55-0.70)	0.67^a (0.56-0.79)	0.59^a (0.51-0.66)	0.60^a (0.54-0.67)	0.73^a (0.63-0.83)	0.62 (0.39-0.85)

NLR 0, baseline neutrophil-lymphocyte ratio; NLR 1, on day 1; NLR 2, on day 2; NLR 3, on day 3;

^aP value < 0.05. Cx: Complications; adm: Admission; NLR: Neutrophil-lymphocyte ratio.

Table 5 Sensitivity, specificity, postitive predictive value, negative predictive value, and accuracy of optimal cut-off value of baseline and on day 1 neutrophil-lymphocyte ratio in predicting severe acute pancreatitis and organ failure

	Cut-off value	P value	Sensitivity	Specificity	PPV	NPV	Accuracy
SAP	NLR 0 = 4.76	0.013	68.6%	50.0%	18.6%	90.5%	52.7%
SAP	NLR 1 = 5.18	0.002	62.9%	55.5%	18.7%	89.6%	46.9%
Organ failure	NLR 0 = 5.03	0.032	64.3%	53.1%	8.3%	95.6%	49.4%
Organ failure	NLR 1 = 4.81	0.003	62.9%	55.5%	8.7%	96.0%	49.2%

P < 0.05. NLR 0, baseline neutrophil-lymphocyte ratio; NLR 1, on day 1; PPV: Positive predictive value; NPV: Negative predictive value; SAP: Severe acute pancreatitis; NLR: Neutrophil-lymphocyte ratio.

Citation: 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(21): 3883-3889
URL: https://www.wjgnet.com/1007-9327/full/v23/i21/3883.htm
DOI: https://dx.doi.org/10.3748/wjg.v23.i21.3883