Prognostic Utility of Creatinine-to-Albumin Ratio for Stratifying Severity in Acute Cholangitis

To evaluate the utility of the creatinine-to-albumin ratio (CAR) as a predictor of moderate-severe acute cholangitis (AC).

We retrospectively reviewed patients diagnosed with AC between August 1, 2019, and July 31, 2024. Disease severity was graded as mild, moderate, or severe according to the Tokyo Guidelines 2018. We assessed the ability of CAR, white blood cell count, C-reactive protein, and procalcitonin to identify moderate-severe and severe AC.

A total of 515 patients were included: 258 with mild AC, 160 with moderate AC, and 97 with severe AC. CAR, C-reactive protein, procalcitonin, and white blood cell count differed significantly across severity grades. For mild versus moderate-severe AC, CAR had the highest AUC among the four biomarkers (AUC, 0.813; 95% confidence interval, 0.777-0.849). For mild-moderate versus severe AC, CAR also had the highest AUC (AUC, 0.702; 95% confidence interval, 0.647-0.757).

CAR may be a useful and low-cost marker for assessing AC severity. Prospective multicenter studies are needed to confirm these findings.