Early Prediction of Necrosis in Acute Pancreatitis Using Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios: A Prospective Study

Mohamed Ibrahim Maroof Saheb

Abstract: Background: Acute pancreatitis (AP) is an inflammatory disorder with potential progression to pancreatic necrosis, which significantly increases morbidity and mortality. Hematological indices such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have emerged as potential early markers of systemic inflammation. This study aimed to evaluate the utility of NLR and PLR in predicting pancreatic necrosis in patients with AP. Methods: This prospective observational study included 130 patients with acute pancreatitis admitted to Government Royapettah Hospital, Chennai, India, from April 2019 to September 2020. Blood samples were collected at admission (Day 0), 24 hours (Day 1), and 48 hours (Day 2) to calculate NLR and PLR. Pancreatic necrosis was assessed using contrast-enhanced CT (CECT). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NLR and PLR were analyzed, and combined performance was evaluated. Results: The cohort comprised 121 males (93.1%) and 9 females (6.9%), with a mean age of 40.65 ? 7.5 years. Alcohol was the most common etiological factor (96%). Mild pancreatitis accounted for 77.7% of cases, while severe pancreatitis represented 22.3%. NLR demonstrated higher sensitivity and NPV compared to PLR at all time points. At 48 hours, NLR sensitivity and specificity were 62.2% and 91.2%, respectively, while PLR sensitivity and specificity were 59% and 80.2%. Combined assessment of NLR and PLR improved early detection of pancreatic necrosis, achieving the highest diagnostic accuracy. Conclusion: NLR and PLR are elevated in patients with necrotizing pancreatitis, with NLR showing superior predictive performance. Their combined use further enhances early identification of high-risk patients, offering a simple, inexpensive, and readily available tool for early prognostication in acute pancreatitis.

Keywords: Acute pancreatitis, Pancreatic necrosis, Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, Prognostic biomarkers

How to Cite?: Mohamed Ibrahim Maroof Saheb, "Early Prediction of Necrosis in Acute Pancreatitis Using Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios: A Prospective Study", Volume 14 Issue 11, November 2025, International Journal of Science and Research (IJSR), Pages: 269-272, https://www.ijsr.net/getabstract.php?paperid=SR251105182702, DOI: https://dx.doi.org/10.21275/SR251105182702