Mohamad I. Mubder, MD1, Banreet Dhindsa, MD1, Danny Nguyen, DO1, Syed Saghir, MD1, Chad Cross, PhD2, Ranjit Makar, MD1, Gordon Ohning, MD, PhD1
1University of Nevada Las Vegas School of Medicine, Las Vegas, NV; 2University of Nevada School of Medicine, Las Vegas, NV
Introduction: Acute pancreatitis (AP) is a commonly encountered emergency where early identification of severe complicated cases is important. Inflammatory markers like lymphocyte to monocytes ratio (LMR) and Neutrophil to Lymphocytes ratio (NLR) have been utilized as a prognostic tool in various medical condition. In this study, we are evaluating the prognostic values of these markers in Acute pancreatitis and the optimal ratio of severity prediction.
Methods: A retrospective chart review of patients admitted to an academic center with the diagnosis of Acute pancreatitis between August 2015 to September 2018. The patients were identified using ICD-10 codes. LMR and NLR were calculated and compared between complicated AP and non-complicated AP on admission and with change through time over 48 hours. Severity defined using revised Atlanta classification. Descriptive statistics and models were calculated using SPSS software (IBM; v. 25). Epidemiological measures and their associated confidence intervals were calculated using MedCalc (v. 18).
Results: A total of 239 out of 426 patients were eligible to be included. 41 patients had a complicated AP. The LMR showed a significant difference between groups, with the non-complicated cases consistently higher than the complicated cases on admission (F = 11.34, p = 0.001), But there were no significant temporal differences (F = 1.48, p = 0.232) (Fig. 1). The NLR showed a significant difference between groups, with the non-complicated cases consistently lower than the complicated cases on admission (F = 23.11, p < 0.001) and through time on day 1 and day 2 post admission (F = 3.88, p = 0.040), with significant differences notable at both post-admission days (p < 0.05; Fig. 2). Cut points for potential clinical use were investigated using the bound of the 95% confidence interval separating the two groups. LMR cut-point < 2 indicating a complicated case and NLR cut-point > 10.5 indicating a complicated case. Overall sensitivity was low (23-69%); however, specificity was high, (85-92%). Hence, these cut-points were very good at discerning non-complicated cases (Table 1).
Discussion: Our data show persistently low LMR is associated with severe AP and value < 2.0 can be used clinically to predict the severity of AP on admission. It also shows elevated NLR is associated with complicated AP and prolonged ICU stay with a value > 10.5 can be used to predict severe complicated AP throughout the admission.
Citation: Mohamad I. Mubder, MD; Banreet Dhindsa, MD; Danny Nguyen, DO; Syed Saghir, MD; Chad Cross, PhD; Ranjit Makar, MD; Gordon Ohning, MD, PhD. P0921 - THE UTILITY OF INFLAMMATORY MARKERS TO PREDICT ADVERSE OUTCOME IN ACUTE PANCREATITIS: A RETROSPECTIVE STUDY IN A TERTIARY CARE ACADEMIC CENTER. Program No. P0921. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.