Neutrophil/Lymphocyte ratio an accurate and simple tool to identify severe acute pancreatitis and predict mortality risk.

Background: Acute pancreatitis (AP) is among the most frequent gastrointestinal disorders that often require hospitalization with varied prognosis depending on the severity. Early assessment of severity is critical for improved outcomes. Traditional scoring systems are complex and resource intensive. The neutrophil to lymphocyte ratio (NLR) is a biomarker that is simple to estimate, valid, and accurate for predicting severity. Methods: This predictive accuracy study was conducted on 110 patients. NLR values were measured over four days (days 0 3), and patients were grouped into mild acute pancreatitis (MAP) or severe acute pancreatitis (SAP) groups. Operating characteristic (ROC) curves were plotted following logistic regression analysis, for appropriate optimal cutoff values each day. Complications such as acute lung injury, shock, and acute renal failure were also assessed. Results: Of the total 110 patients analysed, 58% were mild, while 42% were severe. Alcohol (57%) was the most common cause followed by gallstones (38%). NLR values were consistently higher in patients with SAP compared to those with MAP on all days. The optimal NLR cutoff values for predicting SAP were 5.66 (area under curve [AUC] 0.998), 4.70 (AUC 0.968), 3.73 (AUC 0.952), and 2.96 (AUC 0.913) on days 0, 1, 2, 3, respectively. Acute lung injury (24.5%) was the most common complication, followed by shock (22%) and acute renal failure (11.5%). Conclusion: NLR has emerged as a reliable and simple biomarker for the early prediction of SAP. Its simplicity and predictive accuracy make it a valuable instrument for stratifying AP patients, especially in resource limited settings. Further studies are needed to integrate NLR into clinical protocols for managing acute pancreatitis.