Diagnostic utility of hematological indices in predicting adverse outcomes and severity of acute pancreatitis based on BISAP and modified Glasgow score

BACKGROUND: The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte-ratio (PLR), and red blood cell distribution width (RDW) are simple indicators of inflammatory status previously established as a severity indicator in distinct disease states. This study aimed to determine the impact of these simple hematologic indices with conventional inflammation markers such as C-reactive pro-tein (CRP) and white blood cells in acute pancreatitis (AP) patients and their relationship with AP risk stratification scores including Bedside Index for Severity of Acute Pancreatitis (BISAP) and modified Glaskow Prognostic score (mGPS) scores.
METHODS: This retrospective study was performed in the emergency department of Canakkale Onsekiz Mart University. A total of 171 patients (male/female: 68 [39.8%]/103 [60.3%]) with AP and 59 age and gender matched healthy subjects (male/female: 23 [39%]/36[61%]) as controls were enrolled in the present study. The patients were grouped according to severity and adverse outcomes according to BISAP and mGPS and a comparative analysis was performed to compare the NLR, PLR, and RDW between groups.
RESULTS: The mean NLR values of AP patients and control group were 9.62±6.34 and 2.04±1.08, respectively (p<0.001), while the mean PLR values of AP patients and control group were 221.83±122.43 and 83.30±38.89, respectively (p<0.001). Except from RDW, all the other hematologic indices were found to be elevated (p<0.05 for WBC; NLR, PLR, and CRP) on both mild and severe disease at disease onset. NLR and PLR showed significant predictive ability for estimating serious complications associated with AP.
CONCLUSION: The present study showed that NLR and PLR is increased in AP. Moreover, peripheral blood NLR and PLR values can predict disease severity and adverse outcomes associated with AP and can be used as an adjunctive marker for estimating disease severity.

BISAP ve Modifiye Glaskow Skoru’na göre akut pankreatitde hastalýk ciddiyetini ve komplikasyonlarýný öngörmede hematolojik parametrelerin rolü

AMAÇ: Nötrofil-lenfosit oraný (NLR), trombosit lenfosit oraný (PLR) ve kýrmýzý kan hücresi daðýlým geniþliði (RDW), daha önce farklý hastalýk durum-larýnda bir þiddet göstergesi olarak tanýmlanmýþ iltihap durumunun basit göstergeleridir. Bu çalýþma, bu basit hematolojik indekslerin akut pankreatit (AP) hastalarýnda CRP ve beyaz kan hücreleri gibi geleneksel enflamasyon belirteçleri ve bunlarýn, Akut Pankreatit Þiddeti Ýçin Ýndeksi (BISAP) ve Modifiye Glaskow Prognostik (mGPS) skorlarý ile iliþkisini deðerlendirmektedir.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma Çanakkale Onsekiz Mart Üniversitesi Acil Servisi’nde yapýldý. Toplam 171 hasta (erkek/kadýn: 68 [%39.8) / 103 [%60.3)] AP’li ve 59 yaþ ve cinsiyet uyumlu saðlýklý (erkek/kadýn: 23 [%39] / 36 [%61]) kontroller bu çalýþmaya dahil edildi. Hastalar BISAP ve mGPS’ye göre ciddiyet ve istenmeyen sonuçlara göre gruplandýrýldý ve gruplar arasýnda NLR, PLR ve RDW deðerlerini karþýlaþtýrmak için analiz edildi.
BULGULAR: Akut pankreatit hastalarýnýn ve kontrol grubunun ortalama NLR deðerleri sýrasýyla 9.62±6.34 ve 2.04±1.08 (p<0.001) iken, AP has-talarýnýn ve kontrol grubunun ortalama PLR deðerleri sýrasýyla 221.83±122.43 ve 83.30±38.89 idi (p<0.001). RDW dýþýnda, diðer tüm hematolojik indekslerin hastalýk baþlangýcýnda, hem hafif hem de þiddetli hastalýkta yükseldiði (WBC için p<0.05; NLR, PLR ve CRP) tespit edildi. NLR ve PLR, AP ile iliþkili ciddi komplikasyonlarý tahmin etmek için önemli olduðu görüldü.
TARTIÞMA: Bu çalýþma AP’de NLR ve PLR’nin arttýðýný göstermiþtir. Ayrýca kan NLR ve PLR deðerleri, AP ile baðlantýlý hastalýk þiddetini ve olumsuz sonuçlarý tahmin edebilir ve hastalýk ciddiyetini tahmin etmek için yardýmcý bir belirteç olarak kullanýlabilir.