Early Prediction of Severity in Acute Pancreatitis using the CRP/Albumin Ratio

Abstract

Background: Acute pancreatitis (AP) is an inflammatory disease that can cause potentially lethal complications. Identifying patients at risk for (moderately) severe AP is crucial for appropriate triaging and intervention decisions. Aim: This preliminary analysis aimed to determine the diagnostic value of the C-reactive protein (CRP)/albumin ratio in predicting (moderately) severe AP within 24 and 48 hours.

Methods: We performed a preliminary analysis of a multicentre retrospective cohort study. Patients were selected from studies conducted in 2008 until 2023 by the Dutch Pancreatitis Study Group and were included if data regarding their initial episode of AP was available. CRP and albumin were collected from the first three days of hospitalization and the highest ratios within 24 and 48 hours were calculated. Univariate and multivariate regressions identified predictors, and ROC analyses evaluated predictive accuracy.

Results: The study included 280 patients of whom 125 had (moderately) severe AP. Overall, CRP levels increased and albumin levels decreased during the disease course, leading to higher CRP/albumin ratios. The highest CRP/albumin ratios within 24 and 48 hours, leucocytes and creatinine were individual predictors of (moderately) severe AP. ROC analyses showed modest predictive values for the highest ratios within 24 and 48 hours, with AUCs of 0.582 and 0.607, respectively. High sensitivity cut offs (±80) showed low specificity.

Conclusion: The highest CRP/albumin ratios within 24 and 48 hours correlated significantly with (moderately) severe AP. However, overall predictive accuracy was modest. Small sample size, distribution of severity, and selection bias may have influenced the results. Future analysis with a larger and more representable population is needed to assess the clinical utility of the CRP/albumin ratio as a predictive marker for AP severity.