title: Neutrophil to lymphocyte ratio predicts persistent organ failure and in-hospital mortality in an Asian Chinese population of acute pancreatitis.
abstract: Neutrophil to lymphocyte ratio (NLR) has frequently been reported as a significant indicator of systemic inflammation in various medical conditions. The association underlying NLR and outcomes in patients with acute pancreatitis (AP) has not been evaluated after the publication of revised Atlanta classification.This was a single-center retrospective diagnostic accuracy study and a cohort outcome study. From 2009 to 2015, Asian Chinese patients with a diagnosis of AP presented within 72 hours from symptom onset and underwent neutrophil, lymphocyte assessment at presentation were included in this study. The outcomes were the occurrence of persistent organ failure (POF), intensive care unit (ICU) stay >7 days, and in-hospital mortality. The relationships of baseline neutrophil, lymphocyte count, and NLR with outcomes were assessed with multivariate Cox regression model.A total of 974 consecutive AP patients were clinically eligible. The mean neutrophils, lymphocytes, and NLR for the entire population were 10.23 ± 4.76  × 10/L, 1.05 ± 0.49  × 10/L, and 12.88 ± 11.25. Overall, 223 (22.9%) of the patients developed with POF, 202 (20.7%) spent more than 7 days in ICU, and 58 (6.0%) died during hospitalization. The NLR had a superior predictive performance than neutrophils and lymphocytes. Using an NLR cutoff of 11, the area under the curves (AUC) were 0.76 for POF, 0.74 for longer ICU stay, and 0.79 for death during hospitalization. After multivariate analysis, NLR ≥ 11 was further identified as an independent prognostic factor (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.00-1.89; HR 1.44, 95% CI 1.03-2.00; HR 2.75, 95% CI 1.12-6.76; all P value < 0.05). Following stratification according to quartiles of NLR, positive trends for the association across increasing NLR quartiles and the 3 outcomes were observed (P values for trends across quartiles were 0.007, 0.016, and 0.028, respectively). The adjusted HRs for highest NLR quartile versus the lowest were 2.80 (95% CI 1.42-5.51) (POF), 2.79 (95% CI 1.37-5.70) (ICU > 7 days), and 2.22 (95% CI 0.49-10.05) (mortality), respectively.Our data show for the first time that an increased NLR is an independent risk factor for POF, longer ICU stay, and in-hospital mortality in AP.
authors.affiliation: Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province Shanxi Medical University, Taiyuan, Shanxi province Organ Transplantation Center, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu, People's Republic of China.
authors.forename: Yushun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Wu
authors.forename: Liming
authors.initials: L
authors.lastname: Dong
authors.forename: Chong
authors.initials: C
authors.lastname: Yang
authors.forename: Ping
authors.initials: P
authors.lastname: Fan
authors.forename: Heshui
authors.initials: H
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000276:immunology; D010195:Pancreatitis / Q000150:complications / Q000276:immunology* / Q000401:mortality*; D012189:Retrospective Studies