The role of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in predicting the severity of acute biliary pancreatitis.

BACKGROUND

Acute biliary pancreatitis (ABP) is an acute inflammation of the pancreas that can vary in severity, potentially leading to life-threatening complications. Early identification of severe cases is crucial for effective management and improved outcomes. Traditional scoring systems, such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Ranson, are commonly used to assess severity but can be complex and time-consuming. This study aims to assess the reliability of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as accessible biomarkers for predicting ABP severity and to evaluate their relationship with disease severity as determined by the Balthazar grade.

METHODS

This retrospective study analyzed 161 patients diagnosed with acute biliary pancreatitis. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio values were compared with ABP severity as assessed by the Balthazar grade. The correlation between these inflammatory biomarkers and disease severity was examined. The study was approved by the Ümraniye Training and Research Hospital Clinical Research Ethics Committee (approval date: 13.03.2025, approval number: 54) and was conducted in accordance with the Declaration of Helsinki.

RESULTS

Elevated NLR and PLR values were significantly associated with increased ABP severity. Both NLR and PLR demonstrated potential as reliable biomarkers for early risk stratification, particularly in resource-limited settings.

CONCLUSION

NLR and PLR may serve as valuable biomarkers in predicting ABP severity, facilitating early clinical decision-making, particularly in settings where advanced imaging is limited. This study also highlights the clinical relevance of these biomarkers within Türkiye, potentially guiding future updates to pancreatitis management protocols.