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Abstract
Objectives Inflammation-based prognostic markers (neutrophil–lymphocyte ratio (NLR), prognostic nutritional index (PNI), red cell distribution width (RDW) and lymphocyte–monocyte ratio (LMR)) are associated with overall survival in some diseases. This study assessed their prognostic value in mortality and severity in acute pancreatitis (AP).
Design A retrospective cohort study.
Setting Patients with AP were recruited from the emergency department at our hospital.
Participants A total of 359 patients with AP (31 non-survivors) were enrolled.
Primary and secondary outcome measures Mortality and severity of AP were the primary and secondary outcome measures, respectively. Biochemistry and haematology results of the first test after admission were collected. Independent relationships between severe AP (SAP) and markers were assessed using multivariate logistic regression models. Mortality prediction ability was evaluated using receiver operating characteristic (ROC) curves. Overall survival was evaluated using the Kaplan-Meier method, with differences compared using the log-rank test. Independent relationships between mortality and each predictor were estimated using the Cox proportional hazard models.
Results Compared with survivors of AP, non-survivors had higher RDW (p<0.001), higher NLR (p<0.001), lower LMR (p<0.001) and lower PNI (p<0.001) at baseline. C reactive protein (CRP; OR=8.251, p<0.001), RDW (OR=2.533, p=0.003) and PNI (OR=7.753, p<0.001) were independently associated with the occurrence of SAP. For predicting mortality, NLR had the largest area under the ROC curve (0.804, p<0.001), with a 16.64 cut-off value, 82.4% sensitivity and 75.6% specificity. RDW was a reliable marker for excluding death owing to its lowest negative likelihood ratio (0.11). NLR (HR=4.726, p=0.004), CRP (HR=3.503, p=0.003), RDW (HR=3.139, p=0.013) and PNI (HR=2.641, p=0.011) were independently associated with mortality of AP.
Conclusions NLR was the most powerful marker of overall survival in this patient series.
- acute pancreatitis
- mortality
- neutrophil-lymphocyte ratio
- prognostic nutritional index
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Footnotes
Contributors RG and YL designed the experiments. RG and YL contributed to the data collection. YZ conducted the data analysis. YL, RG and LF wrote the manuscript. All authors reviewed the manuscript.
Funding This work was financially supported by grants from the Zhejiang Provincial Natural Science Foundation of China (LY15H190002) and the Department of Education Foundation of Zhejiang Province, China (Y201330146).
Competing interests None declared.
Patient consent Obtained.
Ethics approval This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang University School of Medicine, China.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.