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Observational Study
. 2025 Apr 21;31(15):105236.
doi: 10.3748/wjg.v31.i15.105236.

Evaluation of scoring systems and hematological parameters in the severity stratification of early-phase acute pancreatitis

Pei-Na Shi  1 , Zhang-Zhang Song  1 , Xu-Ni He  1 , Jie-Ming Hong  2
Affiliations
Observational Study

Evaluation of scoring systems and hematological parameters in the severity stratification of early-phase acute pancreatitis

Pei-Na Shi et al. World J Gastroenterol. .

Abstract

Background: Acute pancreatitis (AP) is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment. An accurate assessment and precise staging of severity are essential in initial intensive therapy.

Aim: To explore the prognostic value of inflammatory markers and several scoring systems [Acute Physiology and Chronic Health Evaluation II, the bedside index of severity in AP (BISAP), Ranson's score, the computed tomography severity index (CTSI) and sequential organ failure assessment] in severity stratification of early-phase AP.

Methods: A total of 463 patients with AP admitted to our hospital between 1 January 2021 and 30 June 2024 were retrospectively enrolled in this study. Inflammation marker and scoring system levels were calculated and compared between different severity groups. Relationships between severity and several predictors were evaluated using univariate and multivariate logistic regression models. Predictive ability was estimated using receiver operating characteristic curves.

Results: Of the 463 patients, 50 (10.80%) were classified as having severe AP (SAP). The results revealed that the white cell count significantly increased, whereas the prognostic nutritional index measured within 48 hours (PNI48) and calcium (Ca2+) were decreased as the severity of AP increased (P < 0.001). According to multivariate logistic regression, C-reactive protein measured within 48 hours (CRP48), Ca2+ levels, and PNI48 were independent risk factors for predicting SAP. The area under the curve (AUC) values for the CRP48, Ca2+, PNI48, Acute Physiology and Chronic Health Evaluation II, sequential organ failure assessment, BISAP, CTSI, and Ranson scores for the prediction of SAP were 0.802, 0.736, 0.871, 0.799, 0.783, 0.895, 0.931 and 0.914, respectively. The AUC for the combined CRP48 + Ca2+ + PNI48 model was 0.892. The combination of PNI48 and Ranson achieved an AUC of 0.936.

Conclusion: Independent risk factors for developing SAP include CRP48, Ca2+, and PNI48. CTSI, BISAP, and the combination of PNI48 and the Ranson score can act as reliable predictors of SAP.

Keywords: Acute pancreatitis; Prognostic nutritional index; Scoring systems; Severity; Severity stratification.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Receiver operating characteristic curve analysis for predicting severe acute pancreatitis by different parameters. ROC: Receiver operating characteristic; CRP48: C-reactive protein measured within 48 hours; PNI48: Prognostic nutritional index measured within 48 hours; APACHE II: Acute Physiology and Chronic Health Evaluation II; SOFA: Sequential organ failure assessment; BISAP: Bedside index of severity in acute pancreatitis; CTSI: Computed tomography severity index; AUC: Area under the curve.
See this image and copyright information in PMC

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