Investigation of Neutrophil / Lymphocyte Ratio in Patients with Acute Biliary Pancreatitis Presenting to the Emergency Department

Öz

Acute Pancreatitis (AP) is an inflammatory disease of the pancreas, an important cause of abdominal pain, one of the most common causes of emergency services. The aim of this study is to investigate whether the neutrophil / lymphocyte ratio (NLR) can be used as an independent parameter to predict hospitalization time and treatment in patients with acute biliary pancreatitis (ABP). This study was conducted retrospectively by examining the files of patients who were admitted to the Bursa Higher Specialization Training and Research Hospital emergency service between January 1, 2018 and December 31, 2018 and diagnosed with ABP. Age, gender, radiology and laboratory results, length of stay, treatment and discharge status of the patients included in the study were recorded. A total of 141 patients were included in the study and the mean age was 62.12 ± 18.75. 69.5% (n = 98) of the patients were women and the average NLR value was 7.23 ± 7.25, the average amylase level was 1238.21 ± 1180.93, and the mean hospitalization time was 4.79 ± 2.46 days. In the spearman test for nonparametric correlation analysis, there was no relation between the NLR values of the patients and their treatment patterns and final status (p = 0.639, r = -0.040 / p = 0.334, r = 0.080, respectively). It was determined that the NLR values of the patients had a significant relationship with duration of stay and amylase levels (p = 0.027, r = 0.187 / p = 0.000, r = 0.323, respectively). It was determined that the NLR value, which was determined as a determining factor in the prediction of inflammation, infection and post-operative complications, can be used as an independent parameter in predicting the duration of hospitalization of ABP patients.

Anahtar Kelimeler

• emergency service,pancreatitis,cholelitiasis,neutrophil

Acil Servise Başvuran Akut Biliyer Pankreatitli Hastalarda Nötrofil/Lenfosit Oranının İncelenmesi

Öz

Akut Pankreatit (AP), pankreasının inflamatuvar bir hastalığı olup acil servislere en sık başvuru nedenlerinden birisi olan karın ağrısının önemli bir nedenidir. Bu çalışmanın amacı Nötrofil/lenfosit oranı ( NLO) ‘nun akut biliyerpankreatitli (ABP) hastalarda yatış süresini ve tedavisini öngörmede bağımsız bir parametre olarak kullanılıp kullanılmayacağını araştırmaktır. Bu çalışma retrospektif olarak 1 Ocak 2018 ile 31 Aralık 2018 tarihleri arasında Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi ana bina acil servisine başvuran ve ABP tanısı alan hasta dosyaları incelenerek yapılmıştır. Çalışmaya alınan hastaların yaş, cinsiyet, radyoloji ve laboratuvar sonuçları, yatış süreleri, tedavi ve taburculuk durumları kaydedilmiştir. Çalışmaya toplam 141 hasta alınmış olup ortalama yaş 62,12 ± 18,75 olarak saptandı. Hastaların % 69,5 ‘i (n=98) kadın olup ortalama NLO değeri 7,23±7,25, ortalama amilaz düzeyi 1238,21 ± 1180,93, ortalama yatış süresi 4,79 ± 2,46 gün olarak saptandı. Nonparametrik korelasyon analizi için yapılan spearman testinde, hastaların NLO değerlerinin tedavi şekilleri ve son durumları ile bir ilişkisinin varlığı saptanmadı (Sırasıyla p=0,639, r= -0,040/ p=0,343, r= 0,080). Hastaların NLO değerlerinin yatış süreleri ve amilaz düzeyleri ile anlamlı bir ilişkisinin olduğu saptandı (Sırasıyla p=0,027, r= 0,187/ p=0,000, r= 0,323). İnflamasyon, enfeksiyon ve post-operatif komplikasyonların tahmininde belirleyici bir faktör olarak tespit edilen NLO değerinin ABP‘li hastaların yatış sürelerini öngörmede bağımsız bir parametre olarak kullanılabileceği saptanmıştır.

Anahtar Kelimeler

• Acil servis,pankkreatit,safra taşı,nötrofil

Kaynakça

1. 1. Kara H, Doğru A, Değirmenci S, et al. Diagnostic value of neutrophil-to-lymphocyte ratio in emergency department patients diagnosed with acute pancreatitis. Cukurova Medical Journal. 2016;41(1):55-60.
2. 2. Azab B, Jaglall N, Atallah JP, et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]. 2011;11(4):445-452.
3. 3. Forsmark CE, Baillie J. AGA Institute technical review on acute pancreatitis. Gastroenterology. 2007;132(5):2022-2044.
4. 4. Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. The American journal of gastroenterology. 2006;101(10):2379-2400.
5. 5. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-111.
6. 6. Kiriyama S, Gabata T, Takada T, et al. New diagnostic criteria of acute pancreatitis. Journal of hepato-biliary-pancreatic sciences. 2010;17(1):24-36.
7. 7. Yarkaç A, Köse A, Babuş SB, Ateş F, Temel GÖ, Ölmez A. The value of hematological parameters in acute pancreatitis. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES. 2019;25(5):453-460.
8. 8. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil–lymphocyte ratio: experience in patients with cancer. Critical reviews in oncology/hematology. 2013;88(1):218-230.

9. 9. Li J, Chen Q, Luo X, et al. Neutrophil‐to‐lymphocyte ratio positively correlates to age in healthy population. Journal of clinical laboratory analysis. 2015;29(6):437-443.
10. 10. Okuturlar Y, Soylu A, Dogan H, et al. Mean platelet volume in patients with biliary and non-biliary acute pancreatitis. International journal of clinical and experimental pathology. 2015;8(2):2051.
11. 11. Cho JH, Kim TN, Kim SB. Comparison of clinical course and outcome of acute pancreatitis according to the two main etiologies: alcohol and gallstone. BMC gastroenterology. 2015;15(1):87.
12. 12. Halász A, Pécsi D, Farkas N, et al. Outcomes and timing of endoscopic retrograde cholangiopancreatography for acute biliary pancreatitis. Digestive and Liver Disease. 2019.
13. 13. Aydın İ, Ağıllı M, Aydın FN, et al. Farklı yaş gruplarında nötrofil/lenfosit oranı referans aralıkları. Gülhane Tıp Derg. 2015;57:414-418.
14. 14. Suppiah A, Malde D, Arab T, et al. The prognostic value of the neutrophil-lymphocyte ratio (NLR) in acute pancreatitis: identification of an optimal NLR. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2013;17(4):675-681.