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

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; Scoring systems; Severity stratification; Prognostic nutritional index; Severity

Core Tip: Acute pancreatitis (AP) is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment. An accurate assessment and staging of severity are essential in initial intensive therapy. This study systematically explored the prognostic value of inflammatory markers and several scoring systems in severity stratification of early-phase AP. 463 patients with AP were enrolled in this study. The results revealed that C-reactive protein measured within 48 hours, calcium and prognostic nutritional index measured within 48 hours were independent risk factors for predicting severe AP. Computed tomography severity index, bedside index of severity in AP, and the combination of prognostic nutritional index measured within 48 hours and the Ranson score can act as reliable predictor of severity AP.