Clinical study of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in hypertriglyceridemia-induced acute pancreatitis and acute biliary pancreatitis with persistent organ failure

Abstract

Background: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel inflammatory indicators that can be used to predict the severity and prognosis of various diseases. We categorize acute pancreatitis by etiology into acute biliary pancreatitis (ABP) and hypertriglyceridemia-induced acute pancreatitis (HTGP).

Aim: To investigate the clinical significance of NLR and PLR in assessing persistent organ failure (POF) in HTGP and ABP.

Methods: A total of 1450 patients diagnosed with acute pancreatitis (AP) for the first time at Shanxi Bethune Hospital between January 2012 and January 2023 were enrolled. The patients were categorized into two groups according to the etiology of AP: ABP in 530 patients and HTGP in 241 patients. We collected and compared the clinical data of the patients, including NLR, PLR, and AP prognostic scoring systems, within 48 h of hospital admission.

Results: The NLR (9.1 vs 6.9, P < 0.001) and PLR (203.1 vs 160.5, P < 0.001) were significantly higher in the ABP group than in the HTGP group. In the HTGP group, both NLR and PLR were significantly increased in patients with severe AP and those with a SOFA score ≥ 3. Likewise, in the ABP group, NLR and PLR were significantly elevated in patients with severe AP, modified computed tomography severity index score ≥ 4, Japanese Severity Score ≥ 3, and modified Marshall score ≥ 2. Moreover, NLR and PLR showed predictive value for the development of POF in both the ABP and HTGP groups.

Conclusion: NLR and PLR vary between ABP and HTGP, are strongly associated with AP prognostic scoring systems, and have predictive potential for the occurrence of POF in both ABP and HTGP.

Keywords: Acute pancreatitis; Gallstone; Hypertriglyceridemia; Neutrophil-to-lymphocyte ratio; Persistent organ failure; Platelet-to-lymphocyte ratio.

Figure 1

Flow chart of patient enrollment. AP: Acute pancreatitis; HTGP: Hypertriglyceridemia-induced acute pancreatitis; ABP: Acute biliary pancreatitis.

Figure 2

Receiver operating characteristic curve. A: Receiver operating characteristic (ROC) curve for the prediction of persistent organ failure (POF) in hypertriglyceridemia-induced acute pancreatitis by neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the acute pancreatitis (AP) Scoring System; B: ROC curve for the prediction of POF in acute biliary pancreatitis by NLR, PLR, and the AP Scoring System. ROC: Receiver operating characteristic; MCTSI: Modified computed tomography severity index; JSS: Japanese Severity Score; BISAP: Bedside Index for Severity in Acute Pancreatitis; SOFA: Sequential Organ Failure Assessment; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio.