NLR48 is Better Than CRP, and mCTSI, and Similar to BISAP and SOFA Scores for Mortality Prediction in Acute Pancreatitis: A Comparison of 6 Scores

Figures & data

Table 1 Basic Characteristics of Patients with Acute Pancreatitis

		Median (IQR)
Sex M/F (%M)	58.90
Age mean ± std (range)	56.8 ± 17.01 (16–92)	59.00 (43.00–70.00)
Alcohol consumption (%)	270 (37.24%)
Prior pancreatitis (%)	143 (19.72%)
Cirrhosis (%)	16 (2.21%)
Diabetes (%)	126 (17.38%)
Cardiovascular diseases (%)	315 (43.45%%)
Kidney diseases (%)	44 (6.07%)
Laboratory mean values ± std
Hematocrit	40.2 ± 6.5	40.40 (36.20–44.37)
WBC (cells/µL)	13,073± 5158	12,270 (9,430-15,850)
Lymphocyte count (cells/µL)	1484 ± 977	1300 (900.00–1785)
Neutrophile count (cells/µL)	10,696 ± 4856	10,000 (7217–13,160)
NLR0	9.86 ± 7.80	7.87 (4.42–12.86)
Platelet count	209,162 ± 96,281	201,000 (158,000–249,000)
Triglyceride	458.6± 1131.9	106 (68–207)
Urea	46 ± 38.7	35 (25–53)
Creatinine	1.17 ± 1.18	0.81 (0.69–1.15)
Serum glucose	140.8 ± 108.7	113 (89–152)
CRP48	118.8 ± 127.4	63.15 (16.44–198.59)
Calcium	8.1 ± 1	8.1 (7.6–8.6)
Complications (%)
Respiratory	95 (13.10%)
Sepsis	20 (2.76%)
AKI	43 (5.93%)
POF	59 (8.13%)
ICU	99 (13.66%)
Death	57 (7.86%)
Scoring mean ± std
BISAP	1.08 ± 1	1.00 (0.00–2.00)
SOFA	1.49 ± 1.61	1.00 (0.00–2.00)
APACHE II	11.41 ± 5.79	6.00 (4.00–9.00)
mCTSI	2.22 ± 1.77	2.00 (1.00–3.00)

Abbreviations: WBC, white blood cells; NLR, neutrophil–lymphocyte ratio; NLR0, NLR at admission; CRP48, C-reactive protein at 48 h; AKI, acute kidney injury; POF, persistent organ failure; BISAP, BUN–Impaired mental status–SIRS–Age–Pleural effusion; SOFA, Sequential Organ Failure Assessment; mCTSI, modified CT severity index score; IQR, interquartile range (median and IQR reported for variables with non-Gaussian distribution).

Figure 1 AUC for mortality prediction, all patients with acute pancreatitis.

Table 2 AUC and 95% Confidence Interval (CI) for the Prediction of Death and POF in All Patients with Acute Pancreatitis

Death Prediction	AUC	95% CI		P-value	Sens	Spec	Cut-off
-CRP48	0.529	0.400	0.658	0.661	1.000	0.133	11.800
-NLR0	0.596	0.516	0.676	0.019	0.491	0.708	11.324
-NLR48	0.809	0.725	0.893	<0.0001	0.795	0.743	7.466
-NLR48/NLR0	0.676	0.580	0.771	0.000	0.590	0.714	0.836
-mCTSI	0.610	0.507	0.714	0.037	0.529	0.715	2.000
-BISAP	0.827	0.744	0.910	<0.0001	0.757	0.727	1.000
-SOFA	0.809	0.738	0.880	<0.0001	0.630	0.809	2.000
POF prediction
-CRP48	0.513	0.392	0.633	0.838	1.000	0.134	11.800
-NLR0	0.619	0.540	0.698	0.003	0.525	0.710	11.300
-NLR48	0.785	0.703	0.867	< 0.0001	0.750	0.735	7.333
-NLR48/NLR0	0.635	0.544	0.727	0.004	0.545	0.712	0.832
-mCTSI	0.565	0.466	0.664	0.196	0.459	0.712	2.000
-BISAP	0.817	0.735	0.899	< 0.0001	0.744	0.727	1.000
-SOFA	0.848	0.784	0.913	< 0.0001	0.679	0.815	2.000

Note: AUC values with italicized fonts have statistical significance (P-value≤0.05).

Abbreviations: AUC, area under ROC curve; CI, confidence interval; NLR, neutrophil–lymphocyte ratio; NLR0, NLR at admission; NLR48, NLR at 48 hours; NLR48/NLR0, NLR48 to NLR0 ratio; CRP48, C-reactive protein at 48 h; mCTSI, modified CT severity index score; BISAP, BUN–Impaired mental status–SIRS–Age–Pleural effusion; SOFA, Sequential Organ Failure Assessment.

Figure 2 AUC for the prediction of persistent organ failure, all patients with acute pancreatitis.

Table 3 AUC and 95% Confidence Interval (CI) for the Prediction of Death in Patients with Acute Pancreatitis and POF and in Those Admitted to the ICU

POF Patients	AUC	95% CI		P-value	Sens	Spec	Cut-off
-CRP48	0.478	0.215	0.741	0.868	0.688	0.429	12.000
-NLR0	0.453	0.250	0.657	0.654	0.349	0.800	12.875
-NLR48	0.623	0.430	0.816	0.210	0.633	0.700	9.568
-NLR48/NLR0	0.577	0.376	0.778	0.455	0.467	0.800	0.936
-mCTSI	0.512	0.288	0.735	0.919	0.958	0.222	0.000
-BISAP	0.470	0.247	0.694	0.793	0.115	0.889	3.000
-SOFA	0.561	0.366	0.757	0.539	0.475	0.800	4.000
ICU patients
-CRP48	0.459	0.286	0.632	0.641	0.105	0.960	340.60
-NLR0	0.535	0.420	0.649	0.554	0.633	0.490	7.500
-NLR48	0.650	0.527	0.774	0.017	0.588	0.696	9.690
-NLR48/NLR0	0.524	0.395	0.653	0.712	0.206	0.935	1.642
-mCTSI	0.546	0.405	0.687	0.525	0.964	0.154	0.000
-BISAP	0.650	0.522	0.779	0.022	0.484	0.750	2.000
-SOFA	0.692	0.585	0.799	0.000	0.413	0.896	4.000
-APACHE II	0.757	0.650	0.865	<0.0001	0.872	0.538	8.000

Note: AUC values with italicized fonts have statistical significance (P-value≤0.05).

Abbreviations: AUC, area under ROC curve; CI, confidence interval; NLR, neutrophil–lymphocyte ratio; NLR0, NLR at admission; NLR48, NLR at 48 hours; NLR48/NLR0, NLR48 to NLR0 ratio; CRP48, C-reactive protein at 48 h; mCTSI, modified CT severity index score; BISAP, BUN–Impaired mental status–SIRS–Age–Pleural effusion; SOFA, Sequential Organ Failure Assessment.

Figure 3 AUC for mortality prediction in patients with persistent organ failure.

Figure 4 AUC for mortality prediction in patients admitted to the ICU.

Table 4 AUC and 95% Confidence Interval (CI) for the Prediction of Death in Patients with Acute Pancreatitis by Etiology

	Alcoholic Pancreatitis N=201	Biliary Pancreatitis N=308	Hypertriglyceridemic Pancreatitis N=63
CRP48	0.802 (0.587–1.000)	0.580 (0.280–0.880)	0.296 (0.031–0.562)
NLR0	0.504 (0.328–0.681)	0.536 (0.402–0.669)	0.475 (0.213–0.736)
NLR48	0.798 (0.610–0.986)	0.871 (0.754–0.988)	0.544 (0.122–0.966)
NLR48/NLR0	0.682 (0.472–0.891)	0.813 (0.680–0.947)	0.378 (0.010–0.745)
mCTSI	0.730 (0.497–0.964)	0.639 (0.488–0.790)	0.835 (0.483–1.000)
BISAP	0.818 (0.624–1.000)	0.801 (0.669–0.933)	0.784 (0.401–1.000)
SOFA	0.839 (0.691–0.987)	0.677 (0.533–0.821)	0.873 (0.670–1.000)

Note: AUC values with italicized fonts have statistical significance (P-value≤0.05).

Abbreviations: CRP48, C-reactive protein at 48 h; NLR, neutrophil–lymphocyte ratio; NLR0, NLR at admission; NLR48, NLR at 48 hours; NLR48/NLR0, NLR48 to NLR0 ratio; mCTSI, modified CT severity index score; BISAP, BUN-Impaired mental status–SIRS–Age–Pleural effusion; SOFA, Sequential Organ Failure Assessment.