Neutrophil to lymphocyte ratio (NLR) in acute pancreatitis as an early predictor of severity and outcome

Background: The management of Acute Pancreatitis (AP) is determined by an accurate assessment of severity of the disease. Numerous severity indicators have been described till date, most of which require reassessment after admission and resuscitation. We propose a novel indicator, the Neutrophil to Lymphocyte ratio (NLR), as a predictor of severity of acute pancreatitis at the initial time of diagnosis. NLR may have a role in predicting the length of hospital stay and ICU admission and also to predict adverse manifestations of Severe Acute Pancreatitis (SAP) including organ failure.Methods: A retrospective analysis was performed of 107 patients diagnosed with acute pancreatitis based on Atlanta 2012 definitions, who were admitted and treated between August 2017 and November 2017. The patients were grouped according to severity of acute pancreatitis and organ failure occurrence and a comparative analysis was performed to compare the NLR between groups. NLR was also compared with the modified Marshall score as a standard predictor of organ failure in acute pancreatitis.Results: Median NLR among the severe group is significantly higher compared to mild and moderate group (P <0.001). NLR significantly correlated with length of hospital stay (p 0.004) and also had a statistically significant correlation with ICU stay (p < 0.001). We found in our study that NLR at admission correlated significantly with the modified Marshall score in predicting the organ failure (p <0.001) in patients with acute pancreatitis. The receiver operator characteristic (ROC) curve analysis showed a cut-off values of NLR >8.5 at admission correlated with adverse outcomes in patients with acute pancreatitis.Conclusions: Neutrophil to Lymphocyte ratio (NLR) can be used as a predictor of severity of acute pancreatitis, right at the time of initial diagnosis. Further it may predict adverse outcomes, need for ICU care as well as length of hospital stay. NLR can be used as a tool to refer at risk patients to tertiary center needing ICU admission.

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SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Gut ◽

10.1136/gutjnl-2020-323364 ◽

2021 ◽

pp. gutjnl-2020-323364

Author(s):

Sanjay Pandanaboyana ◽

John Moir ◽

John S Leeds ◽

Kofi Oppong ◽

Aditya Kanwar ◽

...

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Organ Failure ◽

Collaborative Study ◽

Length Of Hospital Stay ◽

Secondary Outcome ◽

Icu Admission ◽

Local Complications ◽

Persistent Organ Failure ◽

Increased Risk

ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

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Neutrophil-lymphocyte and hematocrit scoring in acute pancreatitis as an early predictor of severity and outcome

International Surgery Journal ◽

10.18203/2349-2902.isj20202831 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2251

Author(s):

Satish Kumar R. ◽

Sharath A. ◽

Prajwal R. K. ◽

Supreeth K.

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Adverse Outcomes ◽

Apache Ii ◽

Initial Time ◽

Apache Ii Score ◽

Neutrophil Lymphocyte Ratio ◽

Tertiary Center ◽

Severe Group

Background: The management of acute pancreatitis (AP) is determined by an accurate assessment of severity of disease. Numerous severity indicators have been described till date, most of which require reassessment after admission and resuscitation. Authors propose a novel indicator, the neutrophil-lymphocyte and hematocrit (NLH) scoring as a predictor of acute pancreatitis at the initial time of diagnosis. NLH may have a role in predicting the length of hospital stay and intensive care unit admission and also to predict adverse manifestations of severe acute pancreatitis (SAP).Methods: A retrospective analysis of 107 patients done who diagnosed with acute pancreatitis based on Atlanta 2012 definitions, who were admitted and treated between August 2018 and November 2019. NLH score calculated by adding NLR (neutrophil lymphocyte ratio) and Ht (hematocrit) i.e., NLH=NLR+Ht. NLH was also compared with APACHE II score as a standard predictor of prognosis in acute pancreatitis.Results: Median NLH score among the severe group is significantly higher compared to mild and moderate group. NLH score significantly correlated with length of hospital stay and also had a statistically significant correlation with ICU stay. NLH scoring is comparable with APACHE II scoring system in predicting prognosis in acute pancreatitis.Conclusions: NLH score can be used as a predictor of severity of acute pancreatitis, right at the time of initial diagnosis. Further it may predict adverse outcomes, need for ICU care as well as the length of hospital stay. NLH score can be used as a tool to refer at risk patients to tertiary center needing ICU admission.

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Does Neutrophil to Lymphocyte Ratio Predict Hospital Stay in Appendectomy Patients?

International Surgery ◽

10.9738/intsurg-d-15-00249.1 ◽

2016 ◽

Vol 101 (5-6) ◽

pp. 222-226 ◽

Cited By ~ 1

Author(s):

Zulfu Bayhan ◽

Sezgin Zeren ◽

Ertugrul Kargi ◽

Faik Yaylak ◽

Mehmet Korkmaz ◽

...

Keyword(s):

Hospital Stay ◽

Ct Scan ◽

Length Of Hospital Stay ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Postoperative Length ◽

Pathology Reports ◽

The Impact ◽

The Relationship ◽

Histopathologic Findings

We aimed to investigate the relationship between neutrophil to lymphocyte ratio (NLR) and the postoperative length of hospital stay. In addition, the impact of radiologic and histopathologic findings on hospital stay was also evaluated. This was a retrospective study; 103 patients with appendicitis were included. Diagnosis was confirmed with computerized tomography (CT) scans, ultrasonography, and histopathologic examination. Correlations between the length of hospital stay and age; sex; NLR; c-reactive peptide (CRP) levels; appendix diameter on CT scan or ultrasonography; appendix localization; and pathology reports were evaluated. The length of hospital stay was not related to age or sex. The length of hospital stay after appendectomy was correlated with appendix diameter on CT scan and phlegmonous appendicitis, but it was not associated with NLR, CRP levels, or appendix diameter on ultrasonography. This is a pioneer study, given there is no comprehensive study to date evaluating the association between NLR levels and the length of hospital stay of patients with acute appendicitis. NLR is not associated with the length of hospital stay. Appendix diameter with CT scan and appendix pathology reports are correlated with the length of postoperative hospital stay in appendectomy patients.

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Neutrophil to lymphocyte ratio predicts persistent organ failure and in-hospital mortality in an Asian Chinese population of acute pancreatitis

Medicine ◽

10.1097/md.0000000000004746 ◽

2016 ◽

Vol 95 (37) ◽

pp. e4746 ◽

Cited By ~ 12

Author(s):

Yushun Zhang ◽

Wei Wu ◽

Liming Dong ◽

Chong Yang ◽

Ping Fan ◽

...

Keyword(s):

Acute Pancreatitis ◽

Hospital Mortality ◽

Organ Failure ◽

Chinese Population ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Persistent Organ Failure

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OR005: Admission Neutrophil to Lymphocyte Ratio is Associated with Pancreatic Necrosis and Organ Failure in Acute Pancreatitis: A Retrospective Cohort Study

Clinical Nutrition ◽

10.1016/s0261-5614(15)30102-3 ◽

2015 ◽

Vol 34 ◽

pp. S1

Author(s):

Y. Zhang ◽

C. Yang ◽

C. Wang ◽

H. Wu

Keyword(s):

Acute Pancreatitis ◽

Cohort Study ◽

Organ Failure ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Pancreatic Necrosis ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio

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The Utility of Neutrophil-to-Lymphocyte Ratio as a Severity Predictor of Acute Appendicitis, Length of Hospital Stay and Postoperative Complication Rates

Digestive Surgery ◽

10.1159/000440818 ◽

2015 ◽

Vol 32 (6) ◽

pp. 459-463 ◽

Cited By ~ 18

Author(s):

Michael E. Kelly ◽

Asif Khan ◽

Mudassar Riaz ◽

Jarlath C. Bolger ◽

Fidal Bennani ◽

...

Keyword(s):

Acute Appendicitis ◽

Hospital Stay ◽

Postoperative Complication ◽

Length Of Hospital Stay ◽

Neutrophil To Lymphocyte Ratio ◽

Complication Rates ◽

Lymphocyte Ratio

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Validation of ‘Moderately Severe Acute Pancreatitis’ in patients with Acute Pancreatitis

Journal of Nepal Medical Association ◽

10.31729/jnma.2430 ◽

2013 ◽

Vol 52 (192) ◽

Author(s):

Paleswan Joshi Lakhey ◽

Ramesh Singh Bhandari ◽

Brindeshwori Kafle ◽

Keshaw Prasad Singh ◽

Mahesh Khakurel

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Organ Failure ◽

Severe Acute Pancreatitis ◽

Length Of Hospital Stay ◽

Intensive Care Unit Care ◽

Icu Stay ◽

Local Complications ◽

Mild Acute Pancreatitis ◽

Length Of Icu Stay

Introduction: Severe acute pancreatitis, according to Atlanta classification, is a heterogeneous group of patients with different outcomes. The patients with local complications and without organ failure have better outcome. This study has been conducted to determine the proportion of moderately severe acute pancreatitis and validate this subgroup in our population of patients.Methods: A total of 172 patients with the diagnosis of acute pancreatitis were categorized into three groups according to presence or absence of local complications and organ failure as mild acute pancreatitis, moderately severe acute pancreatitis and severe acute pancreatitis and were compared in terms of need for intensive care unit care, length of ICU stay, need for intervention, length of hospital stay and mortality.Results: Fifty seven (33%) were categorized as moderately severe acute pancreatitis. Need for ICU care (19.3% vs 100%, p < 0.001), length of ICU stay (1 vs 9.8 days, p < 0.001), length of hospital stay (8.3±3.7 vs 16.6±8.1 days, p < 0.001) and mortality (0% vs 33.3%, p < 0.001) between moderately severe acute pancreatitis and severe acute pancreatitis was significantly different. Moreover, mild acute pancreatitis and moderately severe acute pancreatitis had no mortality.Conclusions: This study showed that moderately severe acute pancreatitis exists as a separate group different from mild acute pancreatitis and severe acute pancreatitis with no mortality as in mild acute pancreatitis. Keywords: moderately severe acute pancreatitis; Atlanta classification; outcome.

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Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio predict length of hospital stay in myocarditis

Scientific Reports ◽

10.1038/s41598-021-97678-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Moritz Mirna ◽

Lukas Schmutzler ◽

Albert Topf ◽

Uta C. Hoppe ◽

Michael Lichtenauer

Keyword(s):

Hospital Stay ◽

Leukocyte Count ◽

Systolic Function ◽

Length Of Hospital Stay ◽

Neutrophil To Lymphocyte Ratio ◽

Laboratory Parameters ◽

Lymphocyte Ratio ◽

Lv Systolic Function ◽

Prolonged Hospital ◽

Study Laboratory

AbstractNeutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are associated with the severity of various diseases. The aim of this study was to demonstrate the relationship of NLR and MLR with the severity of myocarditis. 202 consecutive patients with myocarditis were retrospectively enrolled in this study. Laboratory parameters and clinical data were extracted from hospital records and discharge letters. Median NLR was 2.48 (IQR 1.55–4.58) and median MLR was 0.42 (IQR 0.39–0.58). NLR and MLR correlated with HF, CRP and leukocyte count, MLR further correlated inversely with LV systolic function (rs = − 0.379, p = 0.030). Both ratios correlated better with length of hospital stay (NLR: rs = 0.435, p = 0.003; MLR: rs = 0.534, p < 0.0001) than CRP, leukocyte count, IL-6 or procalcitonin. AUCs for the prediction of prolonged hospital stay (NLR = 0.75, MLR = 0.80), and optimal cut-offs therefor were calculated. Patients who had in-hospital complications showed a higher NLR, however, this remained statistically insignificant. NLR and MLR correlated with the length of stay, as well as with several clinical and laboratory parameters in patients with myocarditis. Since white blood cell differentials are relatively easy and fast to perform, both ratios could facilitate further risk stratification in affected patients.

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Predictive value of the neutrophil to lymphocyte ratio for disease deterioration and serious adverse outcomes in patients with COVID-19: a prospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-05796-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhi-Yong Zeng ◽

Shao-Dan Feng ◽

Gong-Ping Chen ◽

Jiang-Nan Wu

Keyword(s):

Cohort Study ◽

Hospital Admission ◽

Clinical Outcomes ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Characteristic Curve ◽

Adverse Outcomes ◽

Neutrophil To Lymphocyte Ratio ◽

Predictive Values ◽

Lymphocyte Ratio

Abstract Background Early identification of patients who are at high risk of poor clinical outcomes is of great importance in saving the lives of patients with novel coronavirus disease 2019 (COVID-19) in the context of limited medical resources. Objective To evaluate the value of the neutrophil to lymphocyte ratio (NLR), calculated at hospital admission and in isolation, for the prediction of the subsequent presence of disease progression and serious clinical outcomes (e.g., shock, death). Methods We designed a prospective cohort study of 352 hospitalized patients with COVID-19 between January 9 and February 26, 2020, in Yichang City, Hubei Province. Patients with an NLR equal to or higher than the cutoff value derived from the receiver operating characteristic curve method were classified as the exposed group. The primary outcome was disease deterioration, defined as an increase of the clinical disease severity classification during hospitalization (e.g., moderate to severe/critical; severe to critical). The secondary outcomes were shock and death during the treatment. Results During the follow-up period, 51 (14.5%) patients’ conditions deteriorated, 15 patients (4.3%) had complicated septic shock, and 15 patients (4.3%) died. The NLR was higher in patients with deterioration than in those without deterioration (median: 5.33 vs. 2.14, P < 0.001), and higher in patients with serious clinical outcomes than in those without serious clinical outcomes (shock vs. no shock: 6.19 vs. 2.25, P < 0.001; death vs. survival: 7.19 vs. 2.25, P < 0.001). The NLR measured at hospital admission had high value in predicting subsequent disease deterioration, shock and death (all the areas under the curve > 0.80). The sensitivity of an NLR ≥ 2.6937 for predicting subsequent disease deterioration, shock and death was 82.0% (95% confidence interval, 69.0 to 91.0), 93.3% (68.0 to 100), and 92.9% (66.0 to 100), and the corresponding negative predictive values were 95.7% (93.0 to 99.2), 99.5% (98.6 to 100) and 99.5% (98.6 to 100), respectively. Conclusions The NLR measured at admission and in isolation can be used to effectively predict the subsequent presence of disease deterioration and serious clinical outcomes in patients with COVID-19.

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