~ 47 ~ International Journal of Surgery Science 2021; 5(2): 318-324 E-ISSN: 2616-3470 P-ISSN: 2616-3462 © Surgery Science www.surgeryscience.com 2021; 5(2): 318-324 Received: 03-02-2021 Accepted: 05-03-2021 Mukul Sharma Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India Arun Chauhan Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India Arun Kumar Gupta Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India Jagdish Gupta Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India Manoj Kumar Gandhi Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India Dig Vijay Singh Thakur Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India Yashika Sharma Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India Corresponding Author: Mukul Sharma Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India Haematological markers as a predicting tool for gallstone induced severe acute pancreatitis Mukul Sharma, Arun Chauhan, Arun Kumar Gupta, Jagdish Gupta, Manoj Kumar Gandhi, Dig Vijay Singh Thakur and Yashika Sharma DOI: https://doi.org/10.33545/surgery.2021.v5.i2f.715 Abstract Severe acute pancreatitis (SAP) has high morbidity and mortality. Gallstones being the most common cause, warrants study into the haematological markers for swift and easy prediction of gallstone induced SAP. Patients of gallstone induced acute pancreatitis were included in this study. Blood investigations of all patients were sent within one hour of arrival. Computed Tomography (CT) was done after 72 hours of onset of pain. Values of all haematological markers, BISAP and MCTSI were then calculated. 70 patients were included in this study. Area under the ROC curve and cut offs based on these curves for predicting SAP were calculated for NLR, PLR, LMR, RDW, Blood sugar, BISAP (≥3) and MCTSI (>6). Their sensitivity and specificity were then calculated. All tested variables except blood sugar could predict SAP. PLR turned out to the best predictive factor among all. We suggest a combination of NLR and PLR for detecting maximum cases. Keywords: gallstone induced acute pancreatitis, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, lymphocyte to monocyte ratio, red cell distribution width 1. Introduction Acute Pancreatitis (AP) is a sudden inflammation of the pancreas which can occur due to various causes, of which gallstones and alcohol are the most common ones [1] . The clinical presentation of this disease varies a lot. Most have a mild course, however 15-20% of these patients will develop severe acute pancreatitis (SAP) [2] . Various scoring systems like Ranson, APACHE-II, Bedside Index for Severity in Acute Pancreatitis (BISAP) and Modified computed tomography severity index (MCTSI) are in use around the world, for predicting as to which patients will have a severe attack of acute pancreatitis. C-reactive protein (CRP), procalcitonin, interleukin-6, and interleukin-8 have also been used for prediction of SAP but with only limited efficiency as these tests are expensive and not adequate for this purpose 3 . BISAP was given by Wu et al. in 2008 in order to calculate the risk of mortality in patients of acute pancreatitis [4] . The MCTSI is a modification in the CT severity index introduced by Balthazar et al. in 1994 [5] . The problem with scoring systems is that these are cumbersome as they have multiple variables and also take time to calculate. What is required is a parameter to predict the severity of pancreatitis quickly and easily. Various haematological markers have been in use for prediction of severity of several inflammatory conditions including acute pancreatitis. Neutrophil to lymphocyte ratio (NLR) is rapid and easy to obtain marker for severity prediction in AP. An increase in neutrophil count indicates an acute inflammatory response, whereas a low lymphocyte count is suggestive of deteriorating general health and physiological stress [6, 7] . Hence, NLR provides an added advantage over either of the two parameters alone. Raised serum cortisol and catecholamines in inflammation may play a major role in bringing out these changes in haematological parameters of these patients. Cortisol causes increase in absolute neutrophil count and has an inverse effect on the lymphocyte count [8] . Similarly, catecholamines may lead to increased leukocyte count and decrease in total lymphocytes [9] . Acute inflammation also causes rise in the platelet count. Hence, in some diseases platelet to lymphocyte ratio (PLR) is considered to be a better marker of severity [10-12] and has been applied to AP as well. Red cell distribution width (RDW) has been in use as a prognostic marker for patients admitted to the intensive care units [13] . A continually low lymphocyte to monocyte ratio (LMR) can help us foresee the upcoming SAP on