Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.91
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
Acute pancreatitis (AP) is a common diagnosis in patients presenting with an acute abdomen. Necrotizing pancreatitis occurs in approximately 20%-30% of patients and is associated with significant morbidity and mortality. Necrotic pancreatic collections are one of the most important complications that may need treatment. Minimally invasive techniques including percutaneous catheter drainage (PCD), endoscopic drainage, and minimally invasive surgery are now preferred to open necrosectomy. It is important to predict response to minimally invasive techniques to decide further interventions. The aim of this study was to predict the role of white blood cell count (WBC) and neutrophil to lymphocyte ratio (NLR) in predicting response to PCD.
Previous studies have identified computed tomography density of the collection, organ failure resolution, and volume reduction of the fluid collection after one week of PCD as significant predictors of successful PCD outcomes. A few studies have reported the utility of inflammatory markers in predicting the response to PCD, however, data on WBC and NLR is lacking in this regard. Evaluation of WBC count and NLR is simple, inexpensive, and universally available and we evaluated their role in PCD response prediction.
This was a retrospective study to evaluate the role of WBC and NLR in predicting response to PCD and clinical outcomes in terms of hospital and intensive care unit stay, need for surgery.
We retrospectively analyzed WBC and NLR values 24 h before PCD and successive values at 24, 48, and 72 h after the procedure. The success of PCD was defined as survival (up to 6 wk after discharge from the hospital) without the need for surgery, and patients were divided into two groups (success vs failure) accordingly. The association of the success of PCD with WBC and NLR was assessed. The trend of WBC and NLR was also assessed post PCD.
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. PCD was successful in 109 patients (group 1) and 46 patients (group 2) failed to respond. There was no significant difference in the baseline characteristics between the two groups except 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.
Our study has shown that WBC and NLR values and their trends can be used to predict success of PCD in a timely manner.
WBC and NLR is a simple, safe, and inexpensive tool for predicting response to PCD and can be used to decide the need for further interventions and thus improve patient outcomes.