A commentary on ‘C-reactive protein/lymphocyte ratio as a... : International Journal of Surgery (2024)

Dear Editor,

Acute pancreatitis (AP) stands as one of the prevalent gastrointestinal tract diseases globally, with an estimated incidence ranging from 4.9 to 73.4 cases per 100000 individuals¹. Recognizing the challenging prognosis associated with moderate to severe AP (MSAP) and severe AP (SAP), Chen et al.² undertook a study to explore the correlation between C-reactive protein/lymphocyte ratio (CLR) and the severity of AP. Their findings revealed that CLR exhibited a significant ability to predict the onset of MSAP within the initial 24h of patient admission. Despite these discoveries, certain concerns warrant further discussion.

Firstly, this study had a limited sample size, comprising only 176 mild AP (MAP) and 300 MSAP patients. To assess the comprehensive predictive capability of CLR in determining the severity of AP, it is essential to include a cohort of healthy controls for comparison with MAP patients. In addition, the enrollment of SAP patients is crucial for comparison with MSAP patients.

Secondly, the baseline characteristics of the enrolled patients were incomplete, which may influence the conclusions. Although the authors included age and gender, the body mass index (BMI) information needs to be supplemented since obesity (BMI >30kg/m²) is associated with the severity of AP, and obese patients with AP usually have a severe course³. Moreover, some laboratory indicators were also missing. According to the ‘Guidelines for diagnosis and treatment of acute pancreatitis in China (2021)’, AP is usually diagnosed based on clinical and laboratory indicators, including upper abdominal pain and a notable increase in serum amylase (AMY) or lipase (LIP) exceeding three times the upper limit of normal⁴. Serum AMY and LIP have specific diagnostic values and are often tested when AP is suspected. Serum AMY and LIP are of great significance. Besides, some laboratory indicators associated with the severity of AP are commonly detected and also required, including white blood cells, blood urea nitrogen, creatinine, Ca²⁺ and so on. Furthermore, complications can help us better understand the prognosis of AP. Although diabetes mellitus was considered in this study, peripancreatic effusion was not.

Thirdly, it was demonstrated that CLR exhibited a good discriminatory performance in predicting the occurrence of MSAP. Considering that C-reactive protein (CRP) itself is associated with the severity of AP⁵, it is recommended to compare CLR with CRP. If the CLR is not superior to CRP, the significance of this study will be relatively low. In addition, there also exist certain scoring systems that are used to evaluate the severity of AP, such as the Ranson score, bedside index of acute pancreatitis severity and computed tomography severity index. The comparison between CLR and other scoring systems can provide more insight into the prognostic value of CLR.

Ultimately, patients diagnosed with AP have undergone appropriate hospital-based treatment. The dynamic changes of CLR before and after the treatment can greatly reflect the association between CLR and the severity of AP. This should be the focus of further research.

To summarize, this study has innovatively proposed that CLR can be used as a prognostic marker in patients with AP. Its clinical implications deserve affirmation. More importantly, the solution to the above concerns can further improve its prognostic clinical value.

Ethical approval

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Consent

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Sources of funding

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Author contribution

J.W. and Y.X.: study design and manuscript drafting; H.Z. and Z.X.: critical revision of the manuscript.

Conflicts of interest disclosure

The authors have declared no conflicts of interest.

Research registration unique identifying number (UIN)

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Guarantor

Hua Zhu.

Data availability statement

Not applicable.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Acknowledgements

Not applicable.

References