J Gastroenterol Dig Dis 2016 Volume 1 Issue 2 28 http://www.alliedacademies.org/gastroenterology-and-digestive-diseases/ Research Article Introduction Acute pancreatitis Acute pancreatitis (AP) is an infammatory process of pancreatic tissue, which can affect other distant organ systems. Its severity can range from mild infammation to severe, progressive pancreatic necrosis, and it can lead to multiorgan failure that may have a mortality rate as high as 20% to 30% [1]. Several scoring systems have been proposed to determine its severity. Among these, Balthazar [2,3] and The Early Warning Score (EWS) [4] are calculated from computed tomography fndings and physical examination. Other scoring systems (Ranson criteria, APACHE score, Glasgow and Imrie scores), on the other hand, require combined use of clinical and laboratory variables. While defnitive diagnosis can be made at the end of 48 hours in Ranson and Imrie scores, The Acute Physiology and Chronic Health Evaluation II (APACHE II) score enables physicians to make prognostic predictions at the time of hospital admission [5]. Therefore, there is an ongoing need for a universally accepted, easy-to-use, and highly sensitive parameter for predicting acute pancreatitis severity. Serum markers as procalcitonin, interleukin-6, and interleukin-8, known to be useful markers for predicting AP severity, cannot be widely used due to their cost, unsuitability for clinical use, and limited availability. Total white blood cell count is a routinely used hematological test that is used in various scoring systems to determine acute pancreatitis severity. Neutrophil- Lymphocyte ratio (NLR) has been found superior to total white blood cell count for predicting prognosis [6]. Red blood cell distribution width (RDW) refects erythrocyte distribution volume. Infammatory markers such as C-reactive protein, erythrocyte sedimentation rate, and IL6 have been linked to increased RDW level [7,8]. This study aimed to compare the effcacy of APACHE II scoring system with Neutrophil Lymphocyte Ratio and RDW level in predicting prognosis of patients with acute pancreatitis. Materials and methods This retrospective study was approved by the local ethics committee of Medical Faculty of Dicle University and it included patients over the age of 18 who were diagnosed with Objective: Acute pancreatitis is an infammatory process of pancreatic tissue. Its severity can range from mild infammation to severe, progressive pancreatic necrosis, and it can lead to multiorgan failure that may have a mortality rate as high as 20% to 30%. Materials and Methods: The aim of this study was to compare the effcacy of acute physiology and chronic health evacuation II (APACHE II) scoring system with neutrophil lymphocyte ratio (NLR) and Red blood cell distribution width (RDW) level in predicting prognosis of patients with acute pancreatitis. Healthy subjects were included as the control group. According to the Atlanta classifcation system, patients having an APACHE II score of less than 8 were classifed as the mild pancreatitis group, and those with an APACHE II score of equal to or greater than 8 were classifed as the severe pancreatitis group. Both groups were compared with each other with respect to admission NLR and RDW. Results: The study included a total of 494 patients with a mean age of 59.15 ± 19.46 years, of whom 363 were women and 131 were men. The control group included a total of 47 subjects with a mean age of 57.34 ± 7.17, of whom 18 were men and 29 were women. When we compared the control and patient groups with respect to NLR and RDW values, we found signifcant differences between both groups. The severe pancreatitis group had a signifcantly higher mean NLR compared to the mild pancreatitis group. The dead patients had higher NLR and RDW values compared to the surviving ones, although only the NLR difference between the dead and surviving patients reached statistical signifcance. Conclusion: Both NLR and RDW are elevated in acute pancreatitis, although only NLR should be considered as a readily available, inexpensive, and useful marker for predicting disease severity and mortality. Abstract The comparison of apache ii scores with neutrophil lymphocyte ratio and red cell distribution width for the prediction of prognosis of patients with acute pancreatitis. Murat Orak*, Mehmet Üstündağ, Mehmet Nezir Güllü, Ayhan Özhasenekler, Hasan Mansur Durgun, Cahfer Güloğlu Department of Emergency Medicine, University of Dicle, Diyarbakır, Turkey Accepted on September 30, 2016 Keywords: Neutrophil lymphocyte ratio; APACHE score; Ranson criteria; Imrie scores