Clinical Performance of Hematological Indices as Predictors of Mortality in Patients with Severe Acute Pancreatitis of Biliary Origin in the General Hospital of Zone No. 3, of Aguascalientes, México

Background: Acute pancreatitis is a common disease with a potentially high mortality rate, making early risk assessment essential for optimizing treatment. Objective: To evaluate the clinical performance of hematological indices as predictors of mortality in patients with severe acute biliary pancreatitis admitted to General Hospital Zone No. 3 in Aguascalientes. Material and methods: An instrumental, retrospective, and observational study was conducted at General Hospital Zone No. 3 in Aguascalientes, Mexico, from January 1, 2023, to March 31, 2024. The study included 25 patients over 18 years of age diagnosed with severe acute biliary pancreatitis. Clinical and demographic data were extracted from medical records. The performance of each index was assessed using ROC curves, with sensitivity, specificity, and predictive values calculated at various cutoff points. Fagan's nomograms were used to interpret pre-test and post-test probabilities of mortality. Results: Among the 25 patients evaluated, 36% died. The neutrophil-to-lymphocyte ratio (NLR) demonstrated the best performance as a mortality predictor, with an area under the curve (AUC) of 0.823. The optimal cutoff point was 15.1, with a sensitivity of 78% and a specificity of 88%, confirming its ability to distinguish between patients who died and those who survived. The red cell distribution width (RDW) had an AUC of 0.747, with high sensitivity (89%) but lower specificity (56%) at a cutoff of 15.0, making it a moderately effective predictor. Conversely, the platelet-to-lymphocyte ratio (PLR) performed poorly, with an AUC of 0.451, indicating low predictive value for mortality. Conclusions: The neutrophil-to-lymphocyte ratio (NLR) emerged as the most effective predictor of mortality in this population of patients with severe acute biliary pancreatitis, followed by the red cell distribution width (RDW), which also showed moderate capability in predicting adverse outcomes.