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For the reliable prognosis of severe acute pancreatitis, the combination of CRP48 h and NLR48 h appears to be the best method. Estimation of C-reactive protein level was a good predictive biomarker for mortality.
According to a retrospective study, both C-reactive protein level at 48 hours (CRP48 h) and neutrophil-to-lymphocyte ratio at 48 hours (NLR48 h) were independently linked with severe acute pancreatitis. However, they did not show superiority over the bedside index for severity in acute pancreatitis (BISAP) scores. In this study, the researchers comparatively evaluated simple prognostic markers with the BISAP scoring system for identifying the best predictors of mortality and severity.
On the basis of revised Atlanta criteria, disease severity was stratified. With the aid of receiver operating characteristic curves, the accuracies of markers for predicting severe acute pancreatitis were evaluated. For each marker, the positive and negative predictive value, sensitivity, specificity were estimated. For identifying the independent predictors of severe acute pancreatitis and mortality, multivariate logistic regression analyses were utilized.
To predict severe acute pancreatitis, the area under the curve (AUC) for the BISAP scoring system was considered to be fair. The CRP48 h and NLR48 h exhibited the best AUCs and were independently linked with severe acute pancreatitis. When both the criteria were met, the AUC, sensitivity, and sensitivity were 0.89, 68% and 92% respectively.
Hematocrit at 48 hours and CRP48 h were independently linked with mortality. CRP48 h and NLR48 h were independently linked with severe acute pancreatitis. But, they were not superior to the BISAP score at hospitalization. Evaluation of both NLR48 h and CRP48h was most suitable for forecasting severe acute pancreatitis. For mortality, the level of CRP was a good predictive biomarker. Blood urea nitrogen showed a favorable predictive performance.
The above-mentioned markers investigated at admission did not show superiority to the BISAP score for severe acute pancreatitis prediction. For identifying severe forms, these simple affordable lab tests may be utilized as prognostic biomarkers in individuals admitted to the emergency department with acute pancreatitis, concluded the study authors.
Medicine (Baltimore)
The BISAP score, NLR, CRP, or BUN: Which marker best predicts the outcome of acute pancreatitis?
Greta Maria Dancu et al.
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