ROLE OF SERUM C-REACTIVE PROTEIN (CRP)/ALBUMIN RATIO IN PREDICTING SEVERITY OF ACUTE PANCREATITIS

Abstract

Background: Acute pancreatitis (AP) is a potentially life-threatening inflammatory condition of the pancreas that varies in clinical severity. The CT Severity Index (CTSI) remains the gold standard for assessing AP severity, but its limitations—such as cost, radiation exposure, and limited accessibility—have prompted investigation into alternative diagnostic tools. Among these, the C-reactive protein (CRP) to albumin ratio has emerged as a promising biomarker, though limited studies exist to validate its diagnostic utility.

Objective: To determine the diagnostic accuracy of the CRP/Albumin ratio in predicting acute pancreatitis severity, using the CT Severity Index as the gold standard.

Methods: This cross-sectional validation study was conducted at PAEC General Hospital Islamabad over a six-month period (01-08-2024 to 31-01-2025). A total of 142 patients aged 18–70 years diagnosed with acute pancreatitis were enrolled using non-probability consecutive sampling. After ethical approval and informed consent, baseline investigations including serum amylase, lipase, CRP, and albumin levels were recorded. The CRP/Albumin ratio was calculated, and pancreatitis severity was evaluated using contrast-enhanced CT scan and CTSI scoring. Data were analyzed using IBM-SPSS version 22. Diagnostic parameters such as sensitivity, specificity, PPV, NPV, and accuracy were calculated via 2x2 contingency tables. ROC analysis and likelihood ratios were also computed.

Results: The mean age was 46.33 ± 12.37 years, with 59.2% males. Biliary pancreatitis was most common (54.9%), followed by idiopathic (27.5%) and alcohol-induced (17.6%). The CRP/Albumin ratio averaged 4.61 ± 0.31. It showed a sensitivity of 94.95%, specificity of 74.42%, PPV of 89.52%, NPV of 86.50%, and diagnostic accuracy of 88.73%. The AUC was 0.859 (95% CI: 0.791–0.927), confirming strong diagnostic performance. Subgroup analysis showed consistent results across age, gender, symptoms, and etiologies.

Conclusion: The CRP/Albumin ratio demonstrates high diagnostic accuracy in predicting acute pancreatitis severity and offers a reliable, non-invasive alternative to imaging-based assessment, especially beneficial in resource-limited settings.