Predicting Intensive Care Unit Admission and Mortality in Acute Pancreatitis

Early identification of patients at risk for severe acute pancreatitis (AP) remains challenging. The authors compared the performance of albumin-based ratios in predicting intensive care unit (ICU) admission and mortality among patients with AP.

This retrospective cohort study included 499 patients with AP. The C-reactive protein (CRP)/albumin ratio (CAR), glucose/albumin ratio (GAR), lactate dehydrogenase/albumin ratio (LAR), and red cell distribution width/albumin ratio (RAR) were calculated at admission and during the early phase of hospitalization. The need for ICU admission was the primary outcome.

Eleven patients (2.2%) required ICU admission, and 5 (1.0%) died. At admission, CAR was elevated in patients requiring ICU admission (14.27 vs. 3.31, P = .022). At 48 hours, CAR was significantly higher in patients requiring ICU admission (88.86 vs. 13.24, P < .001) and demonstrated high discriminative ability (area under the curve [AUC], 0.921; 95% CI, 0.85-0.98), comparable with that of CRP (AUC = 0.922, P = .964). GAR and RAR demonstrated more modest associations. Exploratory mortality analyses suggested that earlyphase CAR at 48 hours and admission RAR were higher among nonsurvivors.

Early-phase (48 hours) CAR is a reliable predictor of ICU admission in patients with AP, with predictive performance comparable with that of CRP while incorporating albumin status. It may serve as a simple adjunctive tool for early risk stratification.