Neutrophil-to-lymphocyte ratio alone may not be a true indicator of the severity of acute pancreatitis

Dear Editor,

We read with interest the recently published article titled “Relationship between the neutrophil-to-lymphocyte ratio (NLR) in acute pancreatitis and the severity and systemic complications of the disease” by Kokulu et al. (1). In this article, the authors aimed to determine the relationship between NLR and the systemic complications and severity of acute pancreatitis. At the end of the article, the authors concluded that elevated NLR is associated with severe acute pancreatitis. We would like to thank the authors for their contribution to the literature.

NLR is used to determine systemic inflammation, and the laboratory test for NLR is globally available and inexpensive. Studies have shown that chronic hepatitis B and/or C infection, renal failure, diabetes mellitus, valvular heart diseases, acute coronary syndromes, thyroid functional abnormalities, metabolic syndrome, essential hypertension, and many inflammatory diseases may affect NLR (2–5). Thus, it would have been more relevant if Kokulu et al. (1) had mentioned these NLR-affecting factors while evaluating the relationship between NLR in acute pancreatitis and the severity and systemic complications of the disease. Furthermore, as an important limitation of the study, it would have been more objective if a large number of patients were included in their research. Moreover, medication may easily alter NLR, so it would have been useful if the patients were described in greater details in terms of their intake of anti-inflammatory drugs, antiviral agents, immunosuppressive drugs, and/or other medications. In addition, it would have been better if the authors had indicated the time elapsed between collecting the blood samples and measuring NLR because waiting period prior to analysis may affect this laboratory parameter (5).

We believe that the findings of Kokulu et al. (1) will lead to further studies concerning predictive role of NLR and severity of acute pancreatitis. However, it should be kept in mind that NLR alone may not be a true indicator of the severity of acute pancreatitis. Finally, we conclude that the severity of acute pancreatitis should be evaluated based on not only NLR but also other clinical, laboratory, and imaging variables.