Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study

Abstract

ObjectivesInflammation-based prognostic markers (neutrophil–lymphocyte ratio (NLR), prognostic nutritional index (PNI), red cell distribution width (RDW) and lymphocyte–monocyte ratio (LMR)) are associated with overall survival in some diseases. This study assessed their prognostic value in mortality and severity in acute pancreatitis (AP).DesignA retrospective cohort study.SettingPatients with AP were recruited from the emergency department at our hospital.ParticipantsA total of 359 patients with AP (31 non-survivors) were enrolled.Primary and secondary outcome measuresMortality and severity of AP were the primary and secondary outcome measures, respectively. Biochemistry and haematology results of the first test after admission were collected. Independent relationships between severe AP (SAP) and markers were assessed using multivariate logistic regression models. Mortality prediction ability was evaluated using receiver operating characteristic (ROC) curves. Overall survival was evaluated using the Kaplan-Meier method, with differences compared using the log-rank test. Independent relationships between mortality and each predictor were estimated using the Cox proportional hazard models.ResultsCompared with survivors of AP, non-survivors had higher RDW (p<0.001), higher NLR (p<0.001), lower LMR (p<0.001) and lower PNI (p<0.001) at baseline. C reactive protein (CRP; OR=8.251, p<0.001), RDW (OR=2.533, p=0.003) and PNI (OR=7.753, p<0.001) were independently associated with the occurrence of SAP. For predicting mortality, NLR had the largest area under the ROC curve (0.804, p<0.001), with a 16.64 cut-off value, 82.4% sensitivity and 75.6% specificity. RDW was a reliable marker for excluding death owing to its lowest negative likelihood ratio (0.11). NLR (HR=4.726, p=0.004), CRP (HR=3.503, p=0.003), RDW (HR=3.139, p=0.013) and PNI (HR=2.641, p=0.011) were independently associated with mortality of AP.ConclusionsNLR was the most powerful marker of overall survival in this patient series.

Correlation between neutrophil/lymphocyte ratio and Ranson score in acute pancreatitis

“…They found a significant association between NLR and the duration of intensive care, the risk of developing persistent organ failure, and mortality. Li et al performed a single‐center retrospective study with 359 AP patients and determined NLR to be the most reliable marker of overall survival. Jeon et al performed a retrospective study with 490 AP patients and established a relationship between NLR, AP severity, and the development of multiorgan failure.…”

Review of Current Evidence in Acute Pancreatitis

“…There is no reliable predictor or a consensus on the preference of use of one or the other systems in case of persistent organ failure. Despite the evidence, no studies have reported a direct relationship between prognostic and mortality markers [67]. On the basis of expert opinions, it is possible to state that despite the simplicity of Ranson's criteria, its convenience to remember, and the wide availability of tests to perform in any laboratory, this prediction rule is full of uncertainties, uncomfortable and confusing as the criteria vary according to the biliary etiology, and instead of evaluating 11 factors, it sometimes evaluates 22.…”

“…It also predicts the duration of hospital stay. It is not useful in determining the severity of organ failure or the number of failed organs [67].…”

Review of Current Evidence in the etiopathogenesis, epidemiology, diagnosis and management of acute pancreatitis

“…Predicts the occurrence of early organ failure with similar or greater precision to SIRS, Bisap and Balthazar, and duration of the hospital stay. It is not useful to differentiate the severity of organ failure, and the number of organs failed [69].…”

“…There is no reliable predictor or consensus on the preference of use of one or the other of the systems for persistent organ failure. Despite the evidence, there are no studies with a direct relationship between prognostic and mortality markers [69]. Based on expert opinions we can say that Ranson's criteria although simple, easy to remember and widely available tests to perform them in any laboratory, it is filled with uncertainties, uncomfortable and confusing as they vary according to the biliary etiology, and instead of evaluating 11 factors become 22.…”