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Table of Contents
Vol. 11, No. 4, 2011
Issue release date: October 2011
Section title: Original Paper
Pancreatology 2011;11:445–452
(DOI:10.1159/000331494)

Neutrophil-Lymphocyte Ratio as a Predictor of Adverse Outcomes of Acute Pancreatitis

Azab B. · Jaglall N. · Atallah J.P. · Lamet A. · Raja-Surya V. · Farah B. · Lesser M. · Widmann W.D.
Departments of aInternal Medicine and bSurgery, Staten Island University Hospital, Staten Island, N.Y., cFeinstein Institute for Medical Research and Hofstra School of Medicine, Manhasset, N.Y., and dState University of New York Downstate Medical Center, Brooklyn, N.Y., USA

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/29/2010
Accepted: 8/4/2011
Published online: 9/28/2011

Number of Print Pages: 8
Number of Figures: 4
Number of Tables: 3

ISSN: 1424-3903 (Print)
eISSN: 1424-3911 (Online)

For additional information: http://www.karger.com/PAN

Abstract

Background: Most acute pancreatitis risk scoring systems use total white blood cell counts (WBC) as one of the risk factors. The value of the neutrophil-lymphocyte ratio (NLR) to predict the severity of acute pancreatitis has not been previously evaluated. Methods:This observational study included 283 patients admitted to a tertiary center between 2004 and 2007. The patients were arranged into tertiles according to NLR and WBC values. The primary outcomes were intensive care unit (ICU) admission and length of stay (LOS) in the hospital. Results: According to NLR tertiles, patients in the 3rd tertile (NLR ≧7.6) had significantly more ICU admissions (17 vs. 2.2%, p < 0.0001) and longer average LOS (6.2 vs. 4.2 days, p < 0.002) compared with those in the 1st tertile (NLR <3.6). According to WBC tertiles, patients in the 3rd tertile had more ICU admissions (12.6 vs. 6.2%, p = 0.12) and a longer average LOS (5.8 vs. 4.4 days, p = 0.059) compared to patients in the 1st WBC tertile, but this did not reach statistical significance. In the multivariate model including NLR, WBC and other predictors, only NLR tertiles (p < 0.0262) and modified early warning scores (p < 0.0025) were significant predictors of ICU admission. Likewise, in the multivariate model of LOS, only NLR and glucose level were significant predictors of longer LOS (p < 0.0161 and p < 0.0053, respectively). Conclusion: NLR is superior to total WBC in predicting adverse outcomes of acute pancreatitis. According to our data, we suggest using the NLR cutoff value of >4.7 as a simple indicator of severity in patients presenting with acute pancreatitis.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/29/2010
Accepted: 8/4/2011
Published online: 9/28/2011

Number of Print Pages: 8
Number of Figures: 4
Number of Tables: 3

ISSN: 1424-3903 (Print)
eISSN: 1424-3911 (Online)

For additional information: http://www.karger.com/PAN


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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References

  1. Neoptolemos JP, Raraty M, Finch M, Sutton R: Acute pancreatitis: the substantial human and financial costs. Gut 1998;42:886–891.
  2. Vege SS YD, Chari ST: pancreatitis; in Talley NJ, Locke GR, Saito YA (eds): GI Epidemiology, ed 1. Malden, Blackwell Publishing, 2007, p 221.
  3. Russo MW, Wei JT, Thiny MT, Gangarosa LM, Brown A, Ringel Y, Shaheen NJ, Sandler RS: Digestive and liver diseases statistics, 2004. Gastroenterology 2004;126:1448–1453.
  4. Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C, Gemmen E, Shah S, Avdic A, Rubin R: The burden of selected digestive diseases in the United States. Gastroenterology 2002;122:1500–1511.
  5. Steinberg WM: Predictors of severity of acute pancreatitis. Gastroenterol Clin North Am 1990;19:849–861.
  6. Lankisch PG, Schirren CA, Kunze E: Undetected fatal acute pancreatitis: why is the disease so frequently overlooked? Am J Gastroenterol 1991;86:322–326.
  7. Windsor JA: Search for prognostic markers for acute pancreatitis. Lancet 2000;355:1924–1925.
  8. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH: Acute pancreatitis: value of CT in establishing prognosis. Radiology 1990;174:331–336.
  9. Chatzicostas C, Roussomoustakaki M, Vardas E, Romanos J, Kouroumalis EA: Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II and III scoring systems in predicting acute pancreatitis outcome. J Clin Gastroenterol 2003;36:253–260.
  10. Garcea G, Jackson B, Pattenden CJ, Sutton CD, Neal CP, Dennison AR, Berry DP: Early warning scores predict outcome in acute pancreatitis. J Gastrointest Surg 2006;10:1008–1015.
  11. Blamey SL, Imrie CW, O’Neill J, Gilmour WH, Carter DC: Prognostic factors in acute pancreatitis. Gut 1984;25:1340–1346.
  12. Corfield AP, Cooper MJ, Williamson RC, Mayer AD, McMahon MJ, Dickson AP, Shearer MG, Imrie CW: Prediction of severity in acute pancreatitis: prospective comparison of three prognostic indices. Lancet 1985;2:403–407.
  13. Dominguez-Munoz JE, Carballo F, Garcia MJ, de Diego JM, Campos R, Yangüela J, de la Morena J: Evaluation of the clinical usefulness of APACHE II and SAPS systems in the initial prognostic classification of acute pancreatitis: a multicenter study. Pancreas 1993;8:682–686.
  14. Ranson JH: Etiological and prognostic factors in human acute pancreatitis: a review. Am J Gastroenterol 1982;77:633–638.
  15. Wilson C, Heath DI, Imrie CW: Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg 1990;77:1260–1264.
  16. Malfertheiner P, Dominguez-Munoz JE: Prognostic factors in acute pancreatitis. Int J Pancreatol 1993;14:1–8.
  17. Triantopoulou C, Lytras D, Maniatis P, Chrysovergis D, Manes K, Siafas I, Papailiou J, Dervenis C: Computed tomography versus Acute Physiology and Chronic Health Evaluation II score in predicting severity of acute pancreatitis: a prospective, comparative study with statistical evaluation. Pancreas 2007;35:238–242.
  18. Garcea G, Gouda M, Hebbes C, Ong SL, Neal CP, Dennison AR, Berry DP: Predictors of severity and survival in acute pancreatitis: validation of the efficacy of early warning scores. Pancreas 2008;37:e54–e61.
  19. Gravante G, Garcea G, Ong SL, Metcalfe MS, Berry DP, Lloyd DM, Dennison AR: Prediction of mortality in acute pancreatitis: a systematic review of the published evidence. Pancreatology 2009;9:601–614.
  20. Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI, Gibson G, Jeffrey RR, Buchan KG, El-Shafei H, Hillis GS: Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 2007;154:995–1002.
  21. Gillum RF, Mussolino ME, Madans JH: Counts of neutrophils, lymphocytes, and monocytes, cause-specific mortality and coronary heart disease: the NHANES-I epidemiologic follow-up study. Ann Epidemiol 2005;15:266–271.
  22. Halazun KJ, Hardy MA, Rana AA, Woodland DC 4th, Luyten EJ, Mahadev S, Witkowski P, Siegel AB, Brown RS Jr, Emond JC: Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Ann Surg 2009;250:141–151.
  23. Sarraf KM, Belcher E, Raevsky E, Nicholson AG, Goldstraw P, Lim E: Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg 2009;137:425–428.
  24. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS: Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008;102:653–657.
  25. Zahorec R: Ratio of neutrophil to lymphocyte counts – rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102:5–14.
  26. Goodman DA, Goodman CB, Monk JS: Use of the neutrophil:lymphocyte ratio in the diagnosis of appendicitis. Am Surg 1995;61:257–259.
  27. Subbe CP, Kruger M, Rutherford P, Gemmel L: Validation of a modified early warning score in medical admissions. QJM 2001;94:521–526.
  28. Garrey W: Variation in white blood cell counts. Physiol Rev 1935;15:597–638.
  29. Skubitz K: Neutrophilic leukocytes; in Greer J, Wintrobe MM (eds): Wintrobe’s Clinical Hematology, ed 12. Philadelphia, Wolters Kluwer/Lippincott Williams & Wilkins Health, 2009, pp 170–193.
  30. Wittel UA, Rau B, Gansauge F, Gansauge S, Nussler AK, Beger HG, Poch B: Influence of PMN leukocyte-mediated pancreatic damage on the systemic immune response in severe acute pancreatitis in rats. Dig Dis Sci 2004;49:1348–1357.
  31. Pavlov P, Uchikov P, Murdzheva M, Tuleva S, Tsvetkova T: Main lymphocyte populations and their subpopulations in patients with acute pancreatitis studied in the course of disease (in Bulgarian). Khirurgiia (Sofiia) 2001;57:4–11.
  32. Pezzilli R, Billi P, Beltrandi E, Casadei Maldini M, Mancini R: Impaired lymphocyte proliferation in human acute pancreatitis. Digestion 1997;58:431–436.
  33. Pezzilli R, Billi P, Beltrandi E, Maldini M, Mancini R, Morselli Labate AM, Miglioli M: Circulating lymphocyte subsets in human acute pancreatitis. Pancreas 1995;11:95–100.
  34. Pezzilli R, Maldini M, Morselli-Labate AM, Barakat B, Romboli E, Beltrandi E, Migliori M, Tomassetti P, Corinaldesi R: Early activation of peripheral lymphocytes in human acute pancreatitis. J Clin Gastroenterol 2003;36:360–363.
  35. Takeyama Y, Takas K, Ueda T, Hori Y, Goshima M, Kuroda Y: Peripheral lymphocyte reduction in severe acute pancreatitis is caused by apoptotic cell death. J Gastrointest Surg 2000;4:379–387.
  36. Bain BJ: Ethnic and sex differences in the total and differential white cell count and platelet count. J Clin Pathol 1996;49:664–666.
  37. Lichtman MA: Cellular deformability during maturation of the myeloblast. Possible role in marrow egress. N Engl J Med 1970;283:943–948.