The Neutrophil-Lymphocyte Ratio as an Early Predictor of Severity and outcome of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Background and study aim: The post-ERCP pancreatitis (PEP) incidence is 3.5%, making it the most frequent complication following ERCP. Pancreatitis is mild-to-moderate in severity in 90% of cases. The current study aims to evaluate the neutrophil-lymphocyte ratio (NLR) as an early predictor of the severity and outcome of post-endoscopic retrograde Cholangiopancreatography pancreatitis. Patients and Methods: The study was conducted on 90 patients who underwent ERCP. 67 with mild/moderate pancreatitis and 23 with severe pancreatitis. Clinical and laboratory evaluation performed including NLR measurement at day 0 & day 1,2 after ERCP. Results: The mean value of NLR on days 1 and 2 was significantly associated with a severe form of acute pancreatitis. Roc curve analysis revealed that, at cut-off point 6.05, NLR at day 1 can predict severe pancreatitis with a sensitivity of 91.3% and specificity of 89.6%. Furthermore, NLR day 2 at cut-off point 5.42 can predict severe pancreatitis with a sensitivity of 91.3% and specificity of 94%. BMI ≥30, history of previous pancreatitis, history of previous PEP, NLR day 1, NLR day 2, a malignant indication of ERCP, duration of the procedure, difficult cannulation, and pancreatic duct contrast were significant risk factors for severe pancreatitis. Multiple logistic regression analysis revealed that NLR day 1 and day 2 were significant independent risk factors for severe pancreatitis. Conclusion: The NLR offers beneficial clinical guidance to better assess the severity of AP. It is also inexpensive, readily available, and has a moderately high prognostic power in predicting the severity, outcome, and overall survival of AP patients.