Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study

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.

Keywords: acute pancreatitis; mortality; neutrophil-lymphocyte ratio; prognostic nutritional index.

Figure 1

ROC curves analysis for predicting mortality by NLR and combined markers in the estimation cohort. ROC, receiver operating characteristic; NLR, neutrophil–lymphocyte ratio; PNI, prognostic nutritional index; RDW, red cell distribution width.

Figure 2

Relationship between inflammation-based prognostic markers and overall survival in patients with acute pancreatitis. A, B, C, D and E show the relationship between NLR, CRP, RDW, PNI and LMR, and overall survival in patients with acute pancreatitis, respectively. CRP, C reactive protein; LMR, lymphocyte–monocyte ratio; NLR, neutrophil–lymphocyte ratio; PNI, prognostic nutritional index; RDW, red cell distribution width.