Comparison of the Accuracy of Modified CT Severity Index Score and Neutrophil-to-Lymphocyte Ratio in Assessing the Severity of Acute Pancreatitis

Abstract

Background Acute pancreatitis is an acute gastrointestinal emergency with significant morbidity and mortality if not treated. It can lead to local as well as systemic complications and has a prevalence of 51.07%. Laboratory investigations such as amylase and lipase and ultrasound scan are typically used for the diagnosis. A contrast-enhanced CT scan is considered the gold standard. Both laboratory and radiological investigation-based scoring systems have been reported in the literature and are in practice. However, these modalities demand several laboratory investigations and are expensive. Our study aims to determine the congruency of the neutrophil-to-lymphocyte ratio (NLR) and the modified CT severity index score (MCTSI) with the revised Atlanta classification in assessing the severity of acute pancreatitis. In addition, the accuracy of NLR and MCTSI is determined. The secondary objective is to determine whether NLR can predict the severity of acute pancreatitis to the same extent as MCTSI through expensive radiological imaging and other clinical scoring systems through a list of investigations. Methodology The data for this study were collected retrospectively and patients with a diagnosis of acute pancreatitis were included through the nonprobability convenience sampling method. All patients underwent relevant laboratory workup (including complete blood count) and radiological workup (including CT scan) during their hospital stay. The main outcome measures were sensitivity, specificity, and accuracy of NLR and MCTSI, and the congruency of these with the revised Atlanta classification in assessing the severity of acute pancreatitis. Results A total of 166 patients with acute pancreatitis were included, of which 107 (64.45%) were males and 59 (35.55%) were females, with a mean age of 43.7. The sensitivity, specificity, and accuracy of NLR were 67%, 90.9%, and 76%, respectively, whereas the sensitivity, specificity, and accuracy of MCTSI were 95%, 13.6%, and 62%, respectively. The area under the curve for NLR was 0.855 whereas that for MCTSI was determined to be 0.645. Conclusions NLR has a good concordance with the revised Atlanta classification and assesses the disease severity, especially in moderate-to-severe cases of acute pancreatitis compared to MCTSI. In addition, NLR can be used in acute and/or resource-poor settings to predict the severity of acute pancreatitis.

NLR48 is Better Than CRP, and mCTSI, and Similar to BISAP and SOFA Scores for Mortality Prediction in Acute Pancreatitis: A Comparison of 6 Scores

“…pancreatitis in the literature was estimated between 0.681 and 0.915, 8,[10][11][12][13][14] and a combined AUC of 0.82 was noted in a meta-analysis. 10 NLR48 was evaluated in a few studies and a meta-analysis for accuracy in predicting severe acute pancreatitis and AUCs between 0.739 and 0.93 were found.…”

“…The neutrophil-lymphocyte ratio (NLR) has been suggested as a reliable marker for predicting inflammation progression and severity of pancreatitis in several studies. [7][8][9][10][11][12][13][14][15][16][17] Acute pancreatic inflammation activates inflammatory cytokines and proteolytic enzymes; 2 a high neutrophil number indicates an acute inflammatory response and a low lymphocyte number a deterioration in the general health condition combined with physiological stress. 10 The NLR can have physiological variations in healthy persons (0.78 to 3.53) and the baseline NLR can therefore influence increased values in acute pancreatitis.…”

“…10,14 In published studies, NLR values at admission (NLR0), in days 1 and 2, and at 48 h (NLR48) were higher in severe acute pancreatitis (SAP) than in those with mild disease, 10,14 and a meta-analysis of 10 papers showed a combined sensitivity of 79% and specificity of 71%, with an AUC of 0.82. 2 Some studies compared the NLR with the BISAP score [11][12][13] or with mCTSI, 11 with similar accuracy.…”

Construction and alidation of a severity prediction model for acute pancreatitis based on CT severity index: A retrospective case-control study

“…CTSI is a radiological scoring system based on CT scan results, designed to objectively quantify the severity of pancreatic inflammation, the presence of pancreatic necrosis, and extrapancreatic complications. Several studies have reported on the potential value of CTSI in predicting the severity and prognosis of AP [5][6][7]. However, the combined effect of CTSI with clinical parameters has not been sufficiently studied.…”

Predictive value of the C-reactive protein/albumin ratio in severity and prognosis of acute pancreatitis

“…At present, a variety of scores are used in the assessment of AP prognoses, such as Ranson, modified computed tomography severity index (MCTSI), and Bedside Index of Severity in Acute Pancreatitis (BISAP) scores (6)(7)(8). However, the calculation of those scores requires the use of numerous parameters and very complicated algorithms, which limits their use in clinical practice (8). Therefore, there is an urgent need for a simpler, faster, realtime tool to predict disease prognosis.…”