RPR (Red Cell Distribution Width to Platelet Ratio): As a Prognostic Marker in Acute Pancreatitis

Abstract

Introduction: Acute pancreatitis is an inflammatory disease of the pancreas with grade of severity ranging from very mild indolent course to severely fatal necrotising pancreatitis. Early detection of the disease severity and early intervention is crucial for favourable outcome. Several prognostic markers and severity scores have been developed and studied to predict the disease severity in acute pancreatitis; but not a single one is ideal. Aim: To study Red-Cell Distribution Width (RDW) to Total Platelet Count (TPC) ratio, shortly RPR (Red Cell Distribution Width to Platelet Ratio); as a prognostic indicator in acute pancreatitis. Materials and Methods: A total of 60 patients with a diagnosis of acute pancreatitis were included in this prospective study. Patients were divided into two groups; mild acute pancreatitis group (MILD AP) and severe acute pancreatitis group (SEVERE AP) according to the revised Atlanta classification 2012 (the severe group includes both moderate and severe acute pancreatitis patients). Patients were followed up till the final outcome that means either death or discharge from the hospital. RPR (RDW/TPC) value was calculated from the complete blood count report for all patients. Various prognostic scores including RANSON’s score, SOFA score, BISAP score, APACHE II, modified Glasgow score were calculated for all patients. RPR and other score values were compared between the discharged and dead patients as well as between the MILD AP group and Severe AP group. Statistical analysis was done using SPSS 21 software and p-value was calculated using the unpaired t-test. Results: The RPR (RDW/TPC) value was found to be significantly higher in patients with severe acute pancreatitis as well as in patients in whom the final outcome was death (p-value <0.001). Using the ROC curve analysis, it was found that at a cut-off value of 0.045 (RDW-CV in % and TPC in x1000/µL) the RPR has a sensitivity of around 90% and a specificity of around 73% in predicting the severity of the disease and with a cut-off value of 0.071, RPR has a sensitivity of around 82% and a specificity of around 96%, in predicting mortality in acute pancreatitis patients. Conclusion: From this study we conclude that RPR is a useful marker of disease severity in acute pancreatitis, especially in early stage.

Keywords

• blood cell parameters
• severe acute pancreatitis
• severity scores
• systemic inflammatory response