NEUTROPHIL TO LYMPHOCYTE RATIO, A NOVEL BEDSIDE PREDICTOR OF ENDOSCOPIC DAMAGE IN CORROSIVE GI INJURIES

Abstract

AIM- To determine an association between neutrophil to lymphocyte ratio (NLR) and severity of endoscopic injury. MATERIALS AND METHODS- A cross-sectional study of 153 adult patients admitted to Madras medical college, following history of caustic ingestion during a 6-month period. The association between NLR within 24 hours of ingestion and endoscopic injury based on Zargar classification was studied. The association between NLR and endoscopic findings were studied. RESULTS AND DISCUSSION- Of the 153 patients studied, 117 had mucosal injuries and 36 normal. 54 of the 117 patients had multi-regional injury and 63 had single regional injuries. Of which, by Zargar classification, Grade I- 57, Grade II- 35 and Grade III-25 patients. Mean NLR of the sample was 3.4. AUC > 80% was noted for NLR cut-offs across all comparison groups namely, High vs lower grades (NLR≥4.32, AUC:0.978, 95% CI 0.95-1.0, p<0.001), a similar Turkish study by Uyar et al had a cut off of 8.7, however the sample size was smaller with only ten patients having poorer graded injuries. The NLR cut-offs of Injured vs non-injured (NLR≥1.49, AUC:0.845, 95% CI 0.78-0.91, p<0.001) and Single vs multi-regional injuries (NLR≥2.27, AUC:0.86, 95% CI 0.80-0.93, p<0.001), were comparable to the previous study. CONCLUSION- Higher NLR values predicted severe and multi-regional injuries. It helped to distinguish between mild and severe injuries, thereby serving as an inexpensive, non-invasive and bedside tool to predict and grade corrosive injuries for patients awaiting or inaccessible to immediate endoscopic evaluation and plan further care.