Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Severity in Pancreatitis

Background:NLR and PLR are inflammation markers derived from routine blood counts. While NLR is linked to poor outcomes in acute pancreatitis (AP), PLR’s prognostic value in AP remains underexplored. This study assess the utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting the severity of acute pancreatitis.Methods:A prospective observational study was conducted from 1st August 2022 to 29th February 2024. Seventy patients aged ≥18 years diagnosed with acute pancreatitis were included. Severity was classified as mild, moderately severe, or severe based on the Revised Atlanta Criteria.Results:NLR showed a significant decreasing trend over time in mild and moderately severe AP (p = 0.033, p = 0.031), but not in severe cases (p = 0.442). PLR changes were not statistically significant across all severity groups. APACHE II scores decreased significantly in mild and moderately severe groups and increased in severe cases (p < 0.001). NLR at admission demonstrated excellent diagnostic accuracy for severe AP (AUROC = 0.96, p = 0.001), with 100% sensitivity and 89% specificity at a cutoff ≥9. PLR showed poor diagnostic performance (AUROC = 0.655, p = 0.254).Conclusion:NLR and PLR are simple, cost-effective markers easily obtained from routine blood tests. In this study, NLR showed higher predictive value for severe AP than PLR. Admission NLR >7.08 or PLR <149.39 suggests MSAP/SAP, while NLR <7.08 or PLR >149.39 indicates likely MAP. These markers can aid early risk stratification and guide timely intervention.