Hematological Indices Predicting the Severity of Acute Pancreatitis Presenting to the Emergency Department: A Retrospective Analysis

Abstract

IntroductionAcute pancreatitis is defined as inflammation of the pancreas. The body responds to inflammation by producing excessive neutrophils and causing programmed cell death of lymphocytes. This leads to immunological instability, which increases the severity of the disease and mortality rate. Recent data suggest that markers of systemic inflammation are able to predict the prognosis of various diseases. Our study aims to assess the severity of acute pancreatitis in conjunction with these hematological markers of systemic inflammation. Materials and methodsOur study was carried out in the emergency medicine department of a tertiary care hospital among patients diagnosed with acute pancreatitis. It was a retrospective study done by reviewing the hospital's medical records. Hematological indices such as hemoglobin levels, packed cell volume (PCV), red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), total leukocyte count (TLC), neutrophil count, lymphocyte count, monocyte count, platelet count, neutrophil to lymphocyte count ratio (NLR), lymphocyte to monocyte ratio (LMR), and platelet to lymphocyte ratio (PLR) were observed to be associated with severity of pancreatitis. Those with computed tomography (CT) severity score >=7 were termed as severe pancreatitis, while those below 7 were considered mild to moderate. ResultsA total of 154 patients were included in the final analysis. The mean age of those patients was 48.47 ± 16.71 years. There were 94 male and 60 female patients. There was no difference found among the study groups with respect to mean hemoglobin levels, RBC count, PCV, MCV, MCH, MCHC, lymphocytes, and platelet counts. TLC (p<0.001), neutrophils (p<0.001), monocytes (p=0.008), NLR (p<0.001), and PLR (p=0.006) were found higher in severe pancreatitis, while LMR was found lower in severe pancreatitis (p=0.003). A linear relationship between the hematological indices and CT severity score has shown that TLC (p=0.015), neutrophils (p=0.005), NLR (p=0.001), and PLR (p<0.001) were positively correlated with severity while lymphocyte count (p=0.004) and LMR (p=0.005) were negatively correlated with severe pancreatitis. TLC and LMR were independent predictors of severe pancreatitis with an adjusted odds ratio of 12.80 and 5.47, respectively, on multivariable regression analysis. ConclusionMany markers correlated with the CT severity score, but few of them were able to demonstrate statistical significance on receiver operating characteristic (ROC) analysis.

Circulating Blood Lymphocytes and Acute Pancreatitis Severity: A Systematic Review

“…This is also true for other inflammatory diseases such as acute pancreatitis and a better understanding of the role of the cells of the adaptative immune system in acute pancreatitis might have a huge impact on the outcomes and future treatments of patients with acute pancreatitis.The neutrophil-tolymphocyte ratio has been shown to be superior to white blood cell count in predicting adverse outcomes of acute pancreatitis [27]. Another study also showed that the neutrophil-to-lymphocyte ratio was related to acute pancreatitis severity [18]. The neutrophil-to-lymphocyte ratio has been shown to be a good indicator of severe disease in inflammatory diseases including sepsis and acute pericarditis.…”

Circulating monocytes in acute pancreatitis

“…Clinically, lymphocyte-to-monocyte ratio (LMR) could serve as one of the predictive indices for persistent organ failure and mortality ( 70 – 75 ). Compared with mild AP (MAP; no organ failure, no local or systemic complications) or moderately severe AP (MSAP; transient organ failure or local or systemic complications) patients, those with severe AP (SAP; persistent organ failure) as defined by the revised Atlanta classification ( 76 ) had a lower LMR ( 71 , 73 , 74 , 77 , 78 ). Paradoxically, SAP patients with uncertain time of disease onset had reduced lymphocyte and monocyte counts at the early stage of their ICU stay, perhaps indicating an immune anergy later in severe disease, which recovered to normal on day 7 ( 79 ).…”

Kombine hematolojik inflamatuar indekslerin akut pankreatit hastalarında kötü sonlanımı öngörmedeki rolü

“…As in every period of inflammation, excessive neutrophils count are produced and cell death begins in the lymphocytes count. [1][2][3] Lymphocyte, neutrophil, and thrombocyte counts can be effective in the inflammation process as well as with the proportional indices between them, and they are also the subject of studies on many chronic inflammatory diseases since they are associated with the prognosis. [4,5] The neutrophil to lymphocyte ratio (NLR) was studied in relation to asthma, [7] chronic obstructive pulmonary disease (COPD), [8] and intensive care patients.…”

“…[9] The neutrophil to lymphocyte ratio (NLR), neutrophil/lymphocyte*platelet ratio (NLPR), systemic inflammation response index (SIRI), and aggregate inflammation systemic index (AISI) were examined in patients diagnosed with thyroiditis, [4] rheumatoid arthritis, [5] and pulmonary fibrosis [6] in order to examine the post-operative inflammatory processes [10] even in patients diagnosed with COVID-19. [11][12][13] Although we know that the effects of hematological parameters on prognosis in patients with pancreatitis have been examined, [3,14] there was no pancreatitis study using hematological inflammatory indices other than NLR, [1,14] and related to the length of hospital stay, mortality, or intensive care hospitalization rates, as far as we can detect. The aim of the instant study is to evaluate the predictability of AISI, NLPR, and SIRI in patients with acute pancreatitis, which predicts more than 7 days of hospitalization, the need for intensive care, and 30-day mortality.…”