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

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 23, Issue 21

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (7707)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-2) series, Tables (1-5) series.

Item

Count

PDF

505

WORD

309

HTML

4429

Figures (1-2)

160

Tables (1-5)

154

Sum=5557

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

891

Download

1259

Sum=2150

Jun 7, 2017 (publication date) through Apr 26, 2024

Times Cited of This Article

Times Cited (58)

Journal Information of This Article

Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

Publisher of This Article

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