Role of serum C-reactive protein (CRP)/Albumin ratio in predicting the severity of acute pancreatitis: A retrospective cohort

Abstract

Acute pancreatitis is a disease with a wide spectrum of severity, complications, and outcome with severe life-threatening complications develop in patients leading to high mortality in severe acute pancreatitis. The rationale of this study is to diagnose the severity of acute pancreatitis using a single test ratio, i.e., CRP/albumin ratio which is a combination of markers for systemic inflammation and nutritional status. All those patients with age group 16-80 years who were diagnosed with acute pancreatitis and admitted subsequently to ICU were included. Severe pancreatitis was determined as CT severity score above 7. About 41% patients out of total 225 had severe pancreatitis. CRP/albumin ratio >4.35 had a sensitivity of 87% and accuracy of 76% to predict acute severe pancreatitis. Elevated CRP/albumin ratio was also associated with complications like multi-organ failure OR: 2.31 [1.3-4.2], duodenal thickening OR: 2.25 [1.2-4.2], and ascites OR: 2.90 [1.5-5.6]. Although, the severity of this elevation varied with different age groups, such non-invasive and readily available parameters should be relied upon admission to risk stratify the patients suffering from pancreatitis. CRP/albumin ratio has higher sensitivity and negative predictive value to predict severe pancreatitis than CRP alone and hence give additional advantage as a prognostic marker, although Delong's test to compare AUROC was indifferent (P-value: 0.22).

Keywords: Acute pancreatitis; Albumin; CRP; ICU; Pancreas; Severity.

Fig. 1

Box-plots representing CRP/albumin ratios among severity of pancreatitis along with pair-wise comparisons with Post-hoc Bonferroni method applied.

Fig. 2

Area under the receiver operating characteristics (AUROC) curves for CRP/albumin ratio (A), CRP alone (B), and both A & B combined (C).