Role of Neutrophil to Lymphocyte Ratio (NLR) and C-Reactive Protein to Albumin Ratio (CAR) as Early Predictors of Severity in Acute Pancreatitis

Authors

  • Nikhil Chandra Roy Junior Consultant, Department of Gastroenterology, Bangladesh Institute of Health Sciences (BIHS) Hospital, Mirpur-1, Dhaka
  • Md Golam Azam Associate Professor and Unit Head, Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) Academy, Dhaka
  • Riad Mohammad Moshaed Hossain Registrar, Dept of GHPD, BIRDEM Academy, Dhaka
  • Sarker Mohammed Sajjad Assistant Professor, Dept of GHPD, BIRDEM Academy, Dhaka
  • Indrajit Kumar Datta Associate Professor, Dept of GHPD, BIRDEM Academy, Dhaka
  • Shireen Ahmed Assistant Professor, Dept of GHPD, BIRDEM Academy, Dhaka
  • Md Abdullah Al Mamoon Associate Professor, Dept of GHPD, BIRDEM Academy, Dhaka
  • AHM Rowshon Professor and Honorary Senior Consultant, Dept of GHPD, BIRDEM Academy, Dhaka

DOI:

https://doi.org/10.3329/bccj.v11i2.69186

Keywords:

Acute Pancreatitis, Neutrophil to Lymphocyte Ratio and C-Reactive Protein to Albumin Ratio

Abstract

Background: Acute pancreatitis (AP) is a life-threatening disease caused by a variety of factors, and once it progresses to severe acute pancreatitis, the prognosis is poor. Different modalities are available for predicting severity in acute pancreatitis. A single, cheap, widely available marker with high sensitivity and specificity is yet to be identified.

Aims and objectives: The present study was aimed to determine the relation of the neutrophil-lymphocyte ratio (NLR) and CRP-Albumin ratio (CAR) in early prediction of severity in acute pancreatitis.

Materials and methods: This cross-sectional study was conducted at the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Shahbagh, Dhaka, Bangladesh, from April, 2020 to March, 2022. Diagnosis of acute pancreatitis was made by clinical findings, serum amylase and lipase levels (>3 times the upper limit of normal values), evidences of acute pancreatitis by ultrasonography and computed tomography (CT). Severity of acute pancreatitis was classified according to the revised version of Atlanta classification. Data collection was done through a structured questionnaire. Data were analyzed by SPSS 23. Receiver operating characteristic (ROC) curve was constructed to estimate the sensitivity and specificity of NLR and CAR.

Results: A total of 120 patients with acute pancreatitis were enrolled in this study. Age of the patients was 45.20±13.93 (mean ±SD) years, male predominance was observed (54.2%). Majority of the cases were mild 52.5% (n=63) compared to moderate 28.3% (n=34) and severe 19.2% (n=23). The NLR was 6.63±3.344 (Mean ± SD) with a range of 1.32 to 18.75. The CAR was 3.20±2.23 (Mean ±SD) with range of 0.14-7.20. The area under the curve (AUC) of NLR and CAR were 0.865 and 0.949 for severity of AP respectively. Sensitivity, specificity, PPV, NPV and accuracy of NLR at cut-off ≥5.72 were 80.7%, 76.2%, 75.4%, 81.4% & 78.3% and that of CAR at cut-off ≥2.07 were 96.5%, 76.2%, 78.6%, 96.0% & 85.8%.

Conclusion: This study revealed that NLR and CAR are good predictors in the assessment of severity of AP. These easily accessible and low-cost inflammatory markers can be used for the management of acute pancreatitis.

Bangladesh Crit Care J September 2023; 11 (2): 83-89

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Published

2023-10-04

How to Cite

Nikhil Chandra Roy, Md Golam Azam, Riad Mohammad Moshaed Hossain, Sarker Mohammed Sajjad, Indrajit Kumar Datta, Shireen Ahmed, Md Abdullah Al Mamoon, & AHM Rowshon. (2023). Role of Neutrophil to Lymphocyte Ratio (NLR) and C-Reactive Protein to Albumin Ratio (CAR) as Early Predictors of Severity in Acute Pancreatitis. Bangladesh Critical Care Journal, 11(2), 83–89. https://doi.org/10.3329/bccj.v11i2.69186

Issue

Vol. 11 No. 2 (2023)

Section

Original Articles

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