Predicting early acute pancreatitis severity using WBC, neutrophil count, NLR, and glucose levels

Early prediction of acute pancreatitis (AP) severity is critical for improving outcomes. This study evaluated the diagnostic value of white blood cell (WBC) count, neutrophil count, neutrophil-to-lymphocyte ratio (NLR), and glucose level for early severity prediction. In this retrospective cohort study, 192 patients with AP (March 2019–December 2021) were stratified by severity using the Revised Atlanta Classification. Blood samples were collected at admission. Demographic and biochemical data were analyzed to identify factors associated with moderately severe (M-SAP) or severe (SAP) AP. Of 192 patients, 61 progressed to M-SAP/SAP. Multivariate analysis identified WBC count, neutrophil count, NLR, and blood glucose as independent predictors for M-SAP/SAP in biliary or alcoholic AP (all P < .05). Receiver operating characteristic curve analysis demonstrated significant predictive value for each individual biomarker. Notably, NLR showed superior predictive accuracy in alcoholic AP (area under the curve [AUC] = 0.828) compared with WBC count (AUC = 0.653) and glucose (AUC = 0.675), whereas WBC count demonstrated higher specificity (84.5%) in biliary AP. WBC count, neutrophil count, NLR, and blood glucose are valuable, independent predictors for early progression to M-SAP/SAP in biliary or alcoholic AP, with each marker reflecting distinct aspects of the inflammatory and metabolic response. A composite model integrating these factors provides enhanced predictive performance (AUC = 0.89). In clinical practice, this simple, cost-effective panel can stratify patients by risk at admission, guide triage decisions, and facilitate early intensive monitoring for high-risk individuals, thereby potentially improving outcomes through timely intervention.