The Relationship between Neutrophil-Lymphocyte Ratio
and Clinal
Laboratory Data in Acute Pancreatitis
Tetiana Formanchuk1,
Hryhoriy Lapshyn2, Mariya Pokidko1, Andrii Formanchuk3,
Igor Vovchuk1
1Department of Surgery №2 with course of
basic stomatology, National Pirogov Memorial Medical University, Vinnytsya,
Ukraine
2Department of Surgery, University
Medical Center Luebeck, Germany
3Department of Surgery №1 with course of
urology, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
SUMMARY
Introduction: Neutrophil-lymphocyte ratio (NLR) is one of the laboratory
biomarkers used in clinical practice to predict severity and mortality of
acute pancreatitis (AP), however, there is currently insufficient
information about the changes of NLR in the dynamics in relationship with
other clinical and laboratory data.
Aims: To assess the relationship between NLR values and other demographics,
clinical and simple laboratory data in patients with acute pancreatitis.
Methods: The data of two hundred twenty-nine patients with AP were analyzed.
All patients were divided into two groups: the group with a positive outcome
and the group with a fatal outcome. NLR was counted on the 1st, 3rd
and 5th day after admission in each group. The dynamics of NLR
index by groups and days, as well as its correlation with other 18 simple
laboratory parameters were evaluated.
Results: The level of NLR rate itself was significantly higher on the 1st,
3rd and 5th day in the group with the fatal result
compared with the group with the positive result (p < 0.05). In patients
with AP with the positive result of treatment, there was a gradual decrease
in the rate between the 1st and the 3rd day (-21.8%)
(p < 0.05). The overall dynamics of the indicator between the 1st
and the 5th day was -21.5%. In contrast to the group of patients
with the fatal outcome, despite the infusion therapy, there was an increase
in NLR rate between the 1st and 3rd day of +15.7%. The
overall dynamics between the 1st and 5th day was
-34.0%. A significant negative relationship of the Spearman's rank
correlation coefficient between NLR on the 1st and 3rd
day with the fatal outcome was revealed. The highest reliability of this
indicator was found on the 3rd day after admission (p < 0.0001).
In the group of patients with a positive result, a correlation between NLR
on the 1st day and stabs on the 1st day, segmental
forms on the 1st day, serum amylase on the 1st day was
found. A very high correlation was found with the level of lymphocytes on
the 1st day (rs = -0.98, p < 0001). In the group of patients with
the fatal outcome, a statistically significant correlation (p < 0.05) of
moderate strength was found between the value of NLR and the following
indicators: glucose level on the 1st day, total protein on the 5th
day, prothrombin index on the 5th day. A high correlation was
found with the level of segmental forms on the 1st day (rs = 0.7)
and a very high correlation with the level of lymphocytes on the 1st
day (rs = -0.99).
Conclusions: There was a significant increase in NLR on the 1st,
3rd, and 5th day in the group of patients with AP with
the fatal outcome compared with the group of patients with AP with the
positive result. Elevated NLR levels on the 1st and 3rd
day seem to be associated with hospital mortality in patients with AP. No
correlation was found between NLR rate and clinical data in the group with
fatal outcome. The main indicators among simple laboratory parameters for
determining the predictors of lethal outcome in AP in different periods
after hospitalization were: the level of blood glucose, lymphocytes, total
protein, serum amylase, prothrombin index.
Keywords: acute pancreatitis, markers,
neutrophil-lymphocyte ratio, laboratory parameters
Corresponding author:
Tetiana Formanchuk
e-mail: mitykt@gmail.com