Comparison of the Inflammatory Markers with the Ranson Scoring System to Predict the Severity of Acute Pancreatitis
Keywords:
Acute Pancreatitis; Neutrophil-to-Lymphocyte Ratio; Lymphocyte-to-Monocyte Ratio; Prognostic Nutritional Index; Severity Prediction.Abstract
OBJECTIVE: To assess the clinical usefulness of inflammation markers, including the Neutrophil-to-Lymphocyte Ratio (NLR), Lymphocyte-to-Monocyte Ratio(LMR), and Prognostic Nutritional Index (PNI), to determine the severity of AP dose in relation to the Ranson score.
METHODOLOGY: The cross-sectional study was conducted in the General Surgery Department of Dr Ruth K.M. Pfau Civil Hospital, Karachi, between January and June 2022. We recruited 288 adult patients with AP using purposive sampling. Patients with chronic pancreatitis, severe comorbid illnesses, or incomplete records were excluded. We recorded laboratory parameters and demographic information on Admission. We used complete blood counts to calculate NLR, LMR, and PNI. We used the Ranson score at Admission and 48 hours to assess severity. We compared the accuracy of the inflammatory measures in diagnosing (sensitivity, specificity, PPV, NPV, AUC) with the Ranson score. SPSS v24.0 was used to analyze the data.
RESULTS: The average age of patients was 41.1±?11.1 years (55.2% were females). The percentage of severe cases of AP was 33%. NLR showed the highest diagnostic accuracy (90.97%), with a sensitivity of 81.1% and specificity of 95.9%, followed by PNI (85.42%) and LMR (80.03%). NLR had better performance among male patients and those aged 50 years or less.
CONCLUSION: NLR is a sensitive early indicator of the severity of acute pancreatitis with good diagnostic performance. It is easy to access; hence, it is an excellent resource for initiating treatment in the early days of AP, until conventional scoring systems are completed.
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