Usage of the Ranson criteria and neutrophil-lymphocyte ratio measured on presentation to the emergency department in the prediction of mortality in acute pancreatitis

The aim of this study is to examine the usefulness of the Ranson criteria and neutrophil-to-lymphocyte ratio (NLR) on admission to the emergency department (ED) in regard to the prediction of mortality for patients diagnosed with acute pancreatitis (AP) and compare the predictive ability of these two parameters. All patients information aged over 18 years who presented to ED and were diagnosed with AP in the three-year study period were analyzed retrospectively. The data were provided from the electronic-based hospital information system. To assess the cut-off value of each variable in discriminating between the survivor and non-survivor groups, the receiver operating characteristic (ROC) analysis and the area under the curve (AUC) were used. This study included 318 adult patients (47.5% male) with a mean age of 58.6 ± 17.6 years. As a result of the ROC analysis of the Ranson criteria for mortality prediction, the AUC value was calculated as 0.65 (95% confidence interval (CI): 0.57–0.70), the Youden index as 0.28, and the p value as 0.002, while the ROC analysis of NLR revealed an AUC value of 0.58 (95% CI: 0.52–0.64), Youden index of 0.29, and p value of 0.08. The Ranson criteria can provide a clinical guide in the prediction of the prognosis of AP patients. However, according to the results of this study, NLR recorded at the time of admission was found to be ineffective on predicting the prognosis of AP patients.

Acute pancreatitis; Neutrophil-lymphocyte ratio; Ranson criteria; Mortality

[1] Roberts SE, Thorne K, Evans PA, Akbari A, Samuel DG, Williams JG. Mortality following acute pancreatitis: social deprivation, hospital size and time of admission: record linkage study. BMC Gastroenterology. 2014; 14: 153.

[2] Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroen-terology guideline: management of acute pancreatitis. American Journal of Gastroenterology. 2013; 108: 1400–1416.

[3] Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet. 2015; 386: 85–96.

[4] Fagenholz PJ, Castillo CF, Harris NS, Pelletier AJ, Camargo CA. Increasing United States hospital admissions for acute pancreatitis, 1988–2003. Annals of Epidemiology. 2007; 17: 491.e1–491.e8.

[5] Waller A, Long B, Koyfman A, Gottlieb M. Acute pancreatitis: updates for emergency clinicians. The Journal of Emergency Medicine. 2018; 55: 769–779.

[6] Mederos MA, Reber HA, Girgis MD. Acute Pancreatitis: A Review. JAMA. 2021; 325: 382–390.

[7] Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surgery, Gynecology & Obstetrics. 1974; 139: 69–81.

[8] Park HS, In SG, Yoon HJ, Lee WJ, Woo SH, Kim D. Predictive values of neutrophil-lymphocyte ratio as an early indicator for severe acute pancreatitis in the emergency department patients. Journal of Laboratory Physicians. 2019; 11: 259–264.

[9] Kong W, He Y, Bao H, Zhang W, Wang X. Diagnostic value of neutrophil-lymphocyte ratio for predicting the severity of acute pancreatitis: a meta-analysis. Disease Markers. 2020; 2020: 1–9.

[10] Akoglu EU, Özdemir S, Rohat Ak, Ozturk TC. The discriminative power of inflammatory markers in patients with mild-to-moderate acute pancreatitis: mean platelet volume, neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, and neutrophil-monocyte product. Southern Clinics of Istanbul Eurasia. 2021; 32: 159–165.

[11] Gomez D, Addison A, De Rosa A, Brooks A, Cameron IC. Retrospective study of patients with acute pancreatitis: is serum amylase still required? BMJ Open. 2012; 2: e001471.

[12] DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44: 837.

[13] Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: a review. JAMA. 2021; 325: 382–390.

[14] de-Madaria E, Capurso G. COVID-19 and acute pancreatitis: examining the causality. Nature Reviews Gastroenterology & Hepatology. 2021; 18: 3–4.

[15] Abaylı B, Gençdal G, Değirmencioğlu Ş. Correlation between neu-trophil/lymphocyte ratio and ranson score in acute pancreatitis. Journal of Clinical Laboratory Analysis. 2018; 32: e22437.

[16] Moreau JA, Zinsmeister AR, Melton LJ, DiMagno EP. Gallstone pancreatitis and the effect of cholecystectomy: a population-based cohort study. Mayo Clinic Proceedings. 1988; 63: 466–473.

[17] Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson’s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. American Journal of Gastroenterology. 2010; 105: 435–441.

[18] Zhang J, Shahbaz M, Fang R, Liang B, Gao C, Gao H, et al. Comparison of the BISAP scores for predicting the severity of acute pancreatitis in Chinese patients according to the latest Atlanta classification. Journal of Hepato-Biliary-Pancreatic Sciences. 2014; 21: 689–694.

[19] Kaplan M, Ates I, Oztas E, Yuksel M, Akpinar MY, Coskun O, et al. A new marker to determine prognosis of acute pancreatitis: PLR and NLR combination. Journal of Medical Biochemistry. 2018; 37: 21–30.

[20] Han C, Zeng J, Lin R, Liu J, Qian W, Ding Z, et al. The utility of neutrophil to lymphocyte ratio and fluid sequestration as an early predictor of severe acute pancreatitis. Scientific Reports. 2017; 7: 10704.

[21] Azab B, Jaglall N, Atallah JP, Lamet A, Raja-Surya V, Farah B, et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology. 2011; 11: 445–452.

[22] Li Y, Zhao Y, Feng L, Guo R. Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study. BMJ Open. 2017; 7: e013206.