Neutrophil-Lymphocyte Ratio (NLR) as Prognostic Marker in Assessing Acute Pancreatitis Outcome

Acute pancreatitis is one of the most common causes of emergency hospital admissions in India. The overall mortality due to acute pancreatitis has remained 10-15% in the past 20 years. The neutrophil–lymphocyte ratio (NLR), calculated from the white cell differential count, provides a rapid indication of the extent of an inflammatory process. AIM OF THIS STUDY: The aim of this study is to determine the optimal ratio for severity prediction, to study the age, sex distribution, and etiology of acute pancreatitis. Severity is defined using modified computed tomography severity index classification for acute pancreatitis. METHODS: We evaluated 100 patients by a cross sectional hospital based study at general surgery department in Tirunelveli Medical College Hospital, Tirunelveli during the period from December 2017 to June 2019. After admission information on age, sex, other complaints, medical history, smoking habit, alcohol consumption, with thorough general and clinical examination of all patients were done. Blood samples were collected within 2hours (day 0) after hospitalization, day1 and day2 . Relevant biochemical and radiological investigation were done. The NLR is defined as the ratio of the absolute neutrophil Count to the absolute lymphocyte count measured. RESULTS: In our study on 100 patients, acute pancreatitis was more predominant among males (95%) than females (5%).55(55%) had mild pancreatitis, 35(35%) moderate pancreatitis and 10(10%) patients had severe acute pancreatitis. Mean age was around 40-50 years. In our study, alcoholic etiology was 92%, gall stone 6%, choledochal cyst 2%. In our study the neutrophil count tend to remain high in severe pancreatitis group compared to mild group .In our study the NLR in mild group is high at the time of admission and tends to decrease towards normalcy on the subsequent days. The NLR in severe group is very high compared to mild group and tends to remain at a higher level compared to mild pancreatitis group. The primary finding in my study is that the neutrophil lymphocyte ratio (NLR) was elevated in patients presenting with acute pancreatitis when compared to the normal (2.63). The optimal ratio of NLR of mild was 4.7± 0.7, the moderate group was 8.3± 1.2 and the severe group was 14.8±1.6. The differences between the severity was statistically very highly significant (p < 0.001). CONCLUSION: NLR can be easily calculated and is a routine workup investigation that is done in all patients at the time of admission. Being a routine investigation, it bears no additional cost to the patient. NLR seems to correlate well with the severity and outcome of acute pancreatitis. Continuous monitoring on each day will provide a dynamic reflection of the immunity and inflammatory response of the body to pancreatitis and hence predict the prognosis earlier. India being a developing country has a low doctor: patient ratio and limited facilities are available at the peripherally located hospitals, it can be used as tool for early referral to higher centre