Neutrophil-to-lymphocyte ratio can specifically predict the severity of hypertriglyceridemia-induced acute pancreatitis compared with white blood cell

Objectives We aimed to evaluate the values of neutrophil-to-lymphocyte ratio (NLR) and white blood cell (WBC) in predicting severity of acute pancreatitis (AP) with different etiologies. Methods We compared NLR and WBC levels in patients with different etiologies and AP severity. The optimal cutoff value for them to predict severe acute pancreatitis (SAP) was determined by receiver operating characteristic (ROC) curve analysis. Results Both NLR and WBC were elevated in patients with SAP. After subgrouping AP by etiology, NLR was predictive of SAP only in hypertriglyceridemia-induced AP (HTG-AP), while WBC could effectively predict severity in both gallstone and HTG-AP. The best cutoff value of WBC for predicting SAP in gallstone AP patients was 12.81 x 10(9)/L, with sensitivity and specificity of 78.9% and 70.2%. The best cutoff value for NLR and WBC to differentiate HTG-SAP was more than 5.88 and 15.89 x 10(9)/L, respectively, with sensitivity and specificity of 87% and 50% for NLR and 56.5% and 75.76% for WBC. Conclusions Our study firstly demonstrated that NLR selectively played a role in HTG-AP, while WBC could predict the severity of both gallstone and HTG-AP. Furthermore, we firstly elucidated that NLR was more sensitive and accurate in judging the severity of HTG-AP compared with WBC.