BackgroundNeutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) predict severity in various diseases. In this study, we evaluated the value of NLR and PLR as prognostic factors in acute pancreatitis (AP).MethodsPatients with AP were prospectively enrolled from March 2014 to September 2016 at Yonsei University Wonju College of Medicine. NLR and PLR were obtained at admission and were compared with other known prognostic scoring systems.ResultsA total of 243 patients were enrolled with an etiology of gallstone (n = 134) or alcohol (n = 109). NLR (17.7 ± 18.3 vs. 8.8 ± 8.4, P <  0.001) and PLR (344.1 ± 282.6 vs. 177.8 ± 150.1, P <  0.001) were significantly higher in the gallstone AP group than in the alcoholic AP group. For gallstone AP, NLR and PLR were significantly higher in severe AP, whereas high NLR and PLR were not related to severe AP in alcoholic AP. For the gallstone AP group, NLR and PLR demonstrated a predictive value significantly superior to C-reactive protein (CRP), whereas NLR, PLR, and CRP were not significant predictors for alcoholic AP.ConclusionOur study demonstrated that NLR and PLR can predict the severity of AP, but only in gallstone AP.

This prospective study investigated the relationship between insulin resistance assessed using the homeostatic model assessment of insulin resistance (HOMA-IR) and the prognosis of acute pancreatitis (AP). A total of 269 patients with AP were recruited in this study. HOMA-IR scores were calculated using fasting insulin and plasma glucose levels. Patients were then categorized into the non-insulin-resistant group (HOMA-IR <2.5) and the insulin-resistant group (HOMA-IR ≥2.5). We performed multivariable logistic regression analysis to investigate the independent association between IR assessed using HOMA-IR and the severity of AP. We also conducted receiver operating characteristic analysis to investigate the predictive ability of HOMA-IR for severe AP. The proportion of patients with severe AP (according to the Atlanta classification) and the percentage of ICU admissions and mortality were higher in patients with insulin resistance than in those without insulin resistance. The area under the curve (AUC) of HOMA-IR for predicting severe AP was 0.719 (95% CI 0.59–0.85, P = 0.003). This value was not significantly different from the AUCs of other AP scoring systems such as CTSI, Ranson, and BISAP. Insulin resistance was the only independent factor for either ICU admission (OR 5.95, 95% CI 1.95–18.15, P = 0.002) or severe AP (OR 6.72, 95% CI 1.34–33.62, P = 0.020). Our findings suggest that the HOMA-IR score is an independent prognostic factor in patients with acute pancreatitis. This finding indicates that insulin resistance is potentially involved in the mechanism for severe AP.

Serum apoB/A-I ratio appears to have value for predicting SAP in patients with AP.

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Background: The atherogenic index of plasma (AIP) reflects the levels of triglycerides (TG) and high-density lipoprotein (HDL) cholesterol. The purpose of this study was to assess the relationship between the AIP and severe acute pancreatitis (SAP). Materials and methods: Patients with acute pancreatitis (AP) were prospectively enrolled from March 2015 to June 2019. The severity of AP was classified according to the 2012 revised Atlanta classification. Mild and moderately severe AP were categorized as non-SAP. The AIP is calculated as log(TG/HDL). Results: A total of 323 patients were enrolled. The etiologies of AP were gallstone in 171 patients (52.9%), alcohol in 122 patients (37.8%), and hypertriglyceridemia in 30 patients (9.3%). Twenty-four patients (7.4%) were classified as SAP. The AIP was significantly higher in the SAP group compared to the non-SAP group (p < 0.001). The AIP was positively correlated with the Atlanta classification (R = 0.256, p < 0.001). In multivariate analysis, the AIP was found to be an independent predictive factor for SAP (OR = 4.571; CI = 1.913–10.922; p = 0.001). Conclusions: The AIP is a potential biomarker for the prediction of SAP in clinical practice. This result provides that impaired lipid metabolism is associated with the severity of pancreatitis.