Role of Clinical Profile, Comorbidities and Neutrophil Lymphocyte Ratio on Prognosis of Acute Pancreatitis

Abstract

Introduction: Acute pancreatitis is the sudden onset of reversible inflammation of pancreas in which pancreatic enzymes cause autodigestion of the gland. Acute pancreatitis varies from mild (mortality rate <1%; usually resolves in several days) to severe (mortality rate can be up to 30%). Aim: The aim of the study was to study the clinical profile, detection of amylase, lipase for diagnosis, progression to pancreatic necrosis and chronic pancreatitis, and Neutrophil Lymphocyte Ratio (NLR) in prognostication of outcome. Materials and Methods: The retrospective study analysed data of patients admitted with acute pancreatitis or presenting to outpatient department (previous medical records) with pancreatitis between January 2011 and September 2016. A total of 339 patients fulfilled the clinical and diagnostic criteria of pancreatitis out of which 252 patients had acute pancreatitis and 78 patients had chronic pancreatitis. Nine patients of acute pancreatitis group were excluded due to lack of complete data and consents. Results: Acute pancreatitis is about six times more common in males than females. The sensitivity and specificity of lipase in our study was 98.41% and 99.19% respectively. The sensitivity and specificity of amylase in our study for the diagnosis of acute pancreatitis was 86.90% and 98.79% respectively. In severe acute pancreatitis, the NLR remains well above normal level for 3-4 days with peak in first or second day indicating ongoing inflammatory process. Conclusion: Serum lipase levels are more sensitive and specific than serum amylase levels and some cases of pancreatitis can be missed if serum amylase alone was measured. Dynamic NLR monitoring i.e., neutrophilia and lymphopenia is cost effective, easy to perform, repeatable and accurate marker for prognosis in severe acute pancreatitis.

Keywords

• amylase
• lipase
• lymphopenia