Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 91-103
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.91
Value of neutrophil-lymphocyte ratio in evaluating response to percutaneous catheter drainage in patients with acute pancreatitis
Pankaj Gupta, Gaurav Chayan Das, Akash Bansal, Jayanta Samanta, Harshal S Mandavdhare, Vishal Sharma, Shano Naseem, Vikas Gupta, Thakur Deen Yadav, Usha Dutta, Neelam Varma, Manavjit Singh Sandhu, Rakesh Kochhar
Pankaj Gupta, Gaurav Chayan Das, Akash Bansal, Manavjit Singh Sandhu, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Jayanta Samanta, Harshal S Mandavdhare, Vishal Sharma, Usha Dutta, Rakesh Kochhar, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Shano Naseem, Neelam Varma, Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Vikas Gupta, Thakur Deen Yadav, Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Gupta P acquired the data, designed the outline of the paper, performed the writing and did the major revisions; Das GC and Bansal A did the majority of the writing, and prepared the figures and tables; Samanta J, Mandavdhare HS, Sharma V, Naseem S, Gupta V, Yadav TD, Dutta U, Varma N, Sandhu MS and Kochhar R contributed to data acquisition as well as to writing; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Postgraduate Institute of Medical Education and Research Institutional Review Board (approval No. INT/IEC/2020/SPL-468).
Informed consent statement: As this was a retrospective study, the need for informed written consent was waived.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pankaj Gupta, MD, Associate Professor, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. pankajgupta959@gmail.com
Received: May 13, 2021
Peer-review started: May 13, 2021
First decision: July 4, 2021
Revised: July 22, 2021
Accepted: November 26, 2021
Article in press: November 26, 2021
Published online: January 7, 2022
Processing time: 231 Days and 7.8 Hours
Abstract
BACKGROUND

Early prediction of response to percutaneous catheter drainage (PCD) of necrotic collections in acute pancreatitis (AP) using simple and objective tests is critical as it may determine patient prognosis. The role of white blood cell (WBC) count and neutrophil-lymphocyte ratio (NLR) has not been assessed as a tool of early prediction of PCD success and is the focus of this study.

AIM

To assess the value of WBC and NLR in predicting response to PCD in AP.

METHODS

This retrospective study comprised consecutive patients with AP who underwent PCD between June 2018 and December 2019. Severity and fluid collections were classified according to the revised Atlanta classification and organ failure was defined according to the modified Marshall Score. WBC and NLR were monitored 24 h prior PCD (WBC-0/NLR-0) and 24 h (WBC-1/NLR-1), 48 h (WBC-2/NLR-2) and 72 h (WBC-3/NLR-3) after PCD. NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. The association of success of PCD (defined as survival without the need for surgery) with WBC and NLR was assessed. The trend of WBC and NLR was also assessed post PCD.

RESULTS

One hundred fifty-five patients [median age 40 ± 13.6 (SD), 64.5% males, 53.5% severe AP] were included in the final analysis. PCD was done for acute necrotic collection in 99 (63.8%) patients and walled-off necrosis in 56 (36.1%) patients. Median pain to PCD interval was 24 ± 69.89 d. PCD was successful in 109 patients (group 1) and 46 patients (group 2) who failed to respond. There was no significant difference in the baseline characteristics between the two groups except the severity of AP and frequency of organ failure. Both WBC and NLR showed an overall decreasing trend. There was a significant difference between WBC-0 and WBC-1 (P = 0.0001). WBC-1 and NLR-1 were significantly different between the two groups (P = 0.048 and 0.003, respectively). The area under the curve of WBC-1 and NLR-1 for predicting the success of PCD was 0.602 and 0.682, respectively. At a cut-off value of 9.87 for NLR-1, the sensitivity and specificity for predicting the success of PCD were calculated to be 75% and 65.4% respectively.

CONCLUSION

WBC and NLR can be used as simple tests for predicting response to PCD in patients with acute necrotizing pancreatitis.

Keywords: Acute pancreatitis; Percutaneous catheter drainage; White blood cell; Neutrophil-lymphocyte ratio; Necrotic collection

Core Tip: Predicting the success of percutaneous catheter drainage (PCD) is critical for a timely decision regarding further interventions. Neutrophilia and lymphopenia are surrogate markers of systemic inflammation and physiological stress. In this study, we evaluate the performance of white blood cell (WBC) and neutrophil-lymphocyte ratio (NLR) as predictors of response to PCD in patients with acute necrotizing pancreatitis. We found a falling trend in both WBC and NLR values, with WBC values showing a significant fall on day one after PCD compared to pre-procedure value.