Role of Platelet-to-Lymphocyte Ratio in Predicting Severity in Acute Pancreatitis: A Systematic Review and Meta-Analysis
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Background: Platelet-to-lymphocyte ratio (PLR) is an inexpensive inflammatory index proposed for early severity stratification in acute pancreatitis (AP), but reported associations, thresholds, and diagnostic performance are inconsistent. This review evaluated PLR in relation to AP severity, persistent organ failure, mortality, and other adverse outcomes. Methods: PubMed/MEDLINE, Google Scholar, and Semantic Scholar were searched, with a September 2026 update using Elicit. Human primary studies assessing PLR in AP severity or prognosis were eligible. Outcomes were stratified by clinical definition to avoid combining Revised Atlanta severe AP, moderately severe/severe AP, persistent organ failure, mortality, imaging-defined severity, and score-defined severity. Risk of bias was assessed according to study type using QUIPS and QUADAS-2. Results: Forty-seven records were screened; 25 primary studies were included. Higher PLR was frequently associated with greater AP severity, but findings were heterogeneous and often attenuated in multivariable or comparative analyses. Reported PLR AUROCs included 0.621-0.720 for severe AP, 0.569-0.731 for persistent organ failure, and 0.693 for 28-day mortality. Sensitivity and specificity varied substantially across thresholds and etiologic subgroups. NLR, CRP-based indices, BISAP, SOFA, modified Marshall, and CT-based scores often showed stronger discrimination. Heterogeneity in severity definitions, timing, etiology, and reporting precluded a single universal PLR threshold or defensible pooled diagnostic estimate. Conclusion: PLR is associated with AP severity in several populations but has inconsistent standalone prognostic performance. Its most appropriate role is as an adjunct to established clinical, laboratory, and radiological assessment rather than an independent severity classifier. Standardized prospective studies are needed with predefined outcome-specific thresholds and timing. Keywords: Keywords: Acute Pancreatitis; Platelet-to-Lymphocyte Ratio; PLR; Disease Severity; Persistent Organ Failure; Prognostic Biomarkers; Inflammatory Markers; Risk Stratification
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