The Discriminative Power of Inflammatory Markers in Patients with Mild-To-Moderate Acute Pancreatitis: Mean Platelet Volume, Neutrophil-Lymphocyte Ratio, Lymphocyte-Monocyte Ratio, and Neutrophil-Monocyte Product

Özet

Objective: The exact parameters that differentiate mild acute pancreatitis (AP) from moderate AP are still unclear. The primary aim of this study was to evaluate the prognostic utility of recently used inflammatory parameters in AP patients. Methods: We retrospectively collected the level of inflammatory parameters of patients who were diagnosed with AP at the onset and remission of the disease. The inflammatory parameters – mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR), neutrophil- monocyte product (NMP), and platelet-lymphocyte ratio (PLR) – were derived from the electronic patient database. The day of the presentation to the emergency department (ED) was accepted as the day of the symptom onset, and the day when the patient declared to be pain free and started to take oral nutrition was accepted as the date of remission. We also calculated the clinical utility metrics such as positive and negative likelihood ratios at this threshold. Results: A total of 217 AP patients were retrieved from the system, and the final study population consisted of 183 AP (84.3%). According to revised Atlanta classification, 142 (77.6%) patients were mild AP (MAP) and 41 (22.4%) were moderate and severe AP (MSAP-SAP). Median neutrophil and lymphocyte counts, PLR, NLR, and NMP were all significantly higher, and lymphocyte-monocyte ratio was significantly lower in MAP group. At remission, the median MPV level was significantly higher (p=0.0062), and median white blood cell (WBC) level was significantly lower (p<0.0001). The same trend was observed in MAP group for both MPV and WBC, but not present for MPV in MSAP-SAP group. Conclusion: We found that all inflammatory markers and ratios were significantly different between MAP and MSAP groups. Among those markers, NLR was the most powerful to discriminate between those groups. During AP from onset to remission, the changes in MPV had no benefit but the change in WBC was significant regardless of AP severity.