Hematologic and Inflammatory Biomarker-Based Prognostic Assessment in Acute Pancreatitis: The Role of CRP, Procalcitonin, and CRP/Albumin Ratio.

Abstract

Background/aims: Acute pancreatitis (AP) is an inflammatory disease with high morbidity and mortality, characterized by the activation of pancreatic enzymes within the pancreas, leading to autolysis. The clinical spectrum of AP ranges from edematous pancreatitis to necrotizing pancreatitis and may result in local complications such as pancreatic necrosis, pseudocysts, and peripancreatic fluid collections. In this study, we aimed to evaluate the prognostic value of daily C-reactive protein (CRP), procalcitonin, and CRP/albumin levels in predicting local complications of pancreatitis.

Materials and methods: The study included 350 patients with AP, who were hospitalised at Bilkent City Hospital, between 1 January 2020 and 31 December 2023. Demographic data, AP etiologies, and biochemical parameters were recorded. The daily trajectories of CRP, procalcitonin, and albumin levels were monitored over 14 days. All statistical analyses were performed using SPSS version 22.

Results: To distinguish cases with and without peripancreatic fluid collection, the cutoff values for CRP on the first, second, and third days were determined as ≥ 30, ≥ 33, and ≥ 59 (AUC: 0.6574; 0.8343; 0.8897), respectively. The cutoff values for procalcitonin were ≥ 0.09, ≥ 0.07, and ≥ 0.12 (AUC: 0.6457; 0.7227; 0.7310), while for CRP/albumin, the cutoff values were ≥ 0.2609, ≥ 1.0476, and ≥ 1.7143 (AUC: 0.6586; 0.8314; 0.8856), respectively. For distinguishing acute peripancreatic fluid collection (APFC) from WON-pseudocyst, the cutoff values for CRP on the first, second, and third days were determined as ≥ 79, ≥ 124, and ≥ 131 (AUC: 0.7428; 0.8360; 0.9613), respectively. The cutoff values for procalcitonin were ≥ 0.18, ≥ 0.13, and ≥ 0.10 (AUC: 0.7403; 0.8493; 0.8967), while for the CRP/albumin ratio, the cutoff values were ≥ 2.000, ≥ 3.000, and ≥ 2.9556 (AUC: 0.7530; 0.8368; 0.9634), respectively. For distinguishing pseudocyst from walled-off necrosis (WON), the cutoff values for CRP on the first, second, and third days were determined as ≥ 234, ≥ 91, and ≥ 229 (AUC: 0.5750; 0.6285; 0.7148), respectively. The cutoff values for procalcitonin were ≥ 0.96, ≥ 0.39, and ≥ 0.69(AUC: 0.6083; 0.6813; 0.7319), while for the CRP/albumin ratio, the cutoff values were ≥ 6.50, ≥ 5.3684, and ≥ 7.3571 (AUC: 0.5603; 0.6357; 0.7456), respectively.

Conclusion: Our study indicated that the daily variations in CRP, procalcitonin, and CRP/albumin ratio were significantly associated with AP complications.