Background & Aim: Acute pancreatitis is a common indication for hospitalization in gastroenterology practice. Rapidly progressing pancreatic inflammation leads to severe acute pancreatitis which accounts for high morbidity and mortality, hence prediction of prognosis on admission is vital. The aim of the study was to analyse the value of neutrophil lymphocyte ratio (NLR) in predicting the severity of acute pancreatitis and to compare with BISAP and modified CT-severity scores. 

Methods: In this retrospective-observational study, patients admitted with diagnosis of acute pancreatitis from January 2015 to December 2019 were included. Demographic data, clinical findings, biochemical and hematologic parameters, details of imaging were collected through electronic medical records. Severity of pancreatitis was classified as per revised Atlanta classification. NLR value and BISAP scores at admission and modified CT-severity index of all subjects were obtained and analysis done. 

Results: Among 106-subjects, 38.7% (n=41) were with severe acute pancreatitis (SAP). The optimal NLR cut-off derived from ROC curve was 6.38 giving sensitivity of 87.8% and specificity 92.3% (AUC 0.945; 95% CI- 0.883 to 0.980) in predicting occurrence of moderate or severe AP, which is better than both BISAP score (>2) and modified CT severity index (>4) in our study. Analysis of binary logistic regression revealed that NLR =6.38 was independently associated with development of SAP (p= <0.001). There was no mortality in our study population. 

Conclusions: NLR value at admission can predict the worsening of acute pancreatitis.