The Neutrophil-Creatinine Index as an Early Predictor of Severe Acute Pancreatitis

Early prediction of severe acute pancreatitis (SAP) remains critical for optimizing initial management. We evaluated the performance of the neutrophil-creatinine index (NCI), a simple biomarker reflecting systemic inflammation and early organ dysfunction, and compared it with established clinical scoring systems.

A retrospective analysis of 380 patients admitted for a first episode of acute pancreatitis between 2016 and 2023 was conducted. The NCI was calculated at admission as neutrophil count × serum creatinine. Predictive performance for SAP was assessed using receiver operating characteristic (ROC) analysis and compared with BISAP, APACHE II, Ranson, and HAPS scores. Multivariate logistic regression models accounting for collinearity were constructed. External validation was performed in an independent cohort of 120 patients.

Severe acute pancreatitis occurred in 22.6% of patients. The NCI demonstrated strong discriminative ability (AUC = 0.832; 95% CI: 0.772-0.892), outperforming HAPS (0.701) and Ranson (0.756), and showing modest but significant improvement over BISAP (0.781; P = 0.04), with comparable performance to APACHE II (0.804; P = 0.08). At a cutoff of 11.27, sensitivity and specificity were 81.2% and 78.2%, respectively. In multivariate analysis excluding its individual components, the NCI remained an independent predictor (OR = 4.08; P < 0.001). External validation confirmed robust performance (AUC = 0.811), with stable sensitivity (80.0%) and specificity (75.3%), and good calibration (Hosmer-Lemeshow P = 0.48).

The NCI provides reliable early prediction of severe acute pancreatitis, with performance comparable or superior to established scoring systems. Its simplicity and immediate availability make it a valuable tool for early risk stratification, particularly in resource-limited settings. Further multicenter validation is warranted.