4 Neutrophil-Lymphocyte Ratio as a Predictor of Severe in Acute Biliary Pancreatitis Keeping the CTSI as a Standard

Abstract Aim The objective of this study is to evaluate Neutrophil-Lymphocyte ratio in foreseeing the severe pancreatitis in the severe acute and early diagnostic phase, keeping the CTSI as standard. Method Validation (cross sectional) study from 20th July 2023 to 19th July 2024 at General surgery ward (1 and 2). A total of 107 patients diagnosed with acute pancreatitis, aged 18-70 years of either gender were included. Patients with diseases such as chronic pancreatitis, diabetes, cardiovascular diseases, trauma, ERCP (iatrogenic), hypertriglyceridemia, alcohol, and end-stage renal and hepatic diseases were excluded. Laboratory investigations included CBC, LFT, serum amylase, serum lipase and ultrasound abdomen. Amylase lipase levels greater than three times normal, and ultrasonographic evidence of cholelithiasis, was reviewed by a surgical specialist; to confirm the diagnosis of acute biliary pancreatitis. All patients underwent CT severity index (CTSI) at 72 hours. Results 41 (38.31%) and 7 (6.54%) came out to be true and false positives respectively in the positive NLR group. Out of 59 (55.14%) who were NLR below cut-off, 55 (55.40%) and 4 (3.73%) were true and false negative respectively. The positive predictive value was 85.42% whereas, the negative predictive value was 93.22%. Sensitivity and specificity were 91.11% and 88.71% respectively. Conclusions It is concluded that NLR remains a highly effective minimally invasive and reproducible method in predicting the outcome of acute pancreatitis, especially in the first few hours of presentation.