Comparative prognostic value of neutrophil-albumin-related ratios to predict mortality in dogs with acute pancreatitis

The prognostic value of hematological ratios incorporating neutrophils and albumin as key factors in the pathophysiology and outcome of acute pancreatitis (AP) in dogs needs assessment. This study compared the predictive power of the neutrophil count-to-lymphocyte ratio (NLR), neutrophil count-to-albumin ratio (NAR), neutrophil percentage-to-albumin ratio (NPAR), and NLR-to-albumin ratio (NLR-Alb) for in-hospital mortality in dogs with AP. This retrospective cohort study included 128 dogs with AP (59.37 % survivors / 40.63 % non-survivors) and 40 healthy dogs. NLR, NAR, NPAR, and NLR-Alb were calculated upon admission. Logistic regression and the area under the receiver-operating characteristic curve (AUROC) evaluated their predictive value. All markers were significantly higher in non-surviving dogs with AP than in survivors. A one-point increase in NLR, NLR-Alb, and NAR increased the mortality risk by 4 %, 12 %, and 16 %, respectively. The AUROC, sensitivity, and specificity at the cutoff for each marker were:.622, 62.75 %, and 61 % for NLR;.708, 64.7 %, and 75.3 % for NAR;.609, 78.4 %, and 44.2 % for NPAR;.649, 82.4 %, and 45.4 % for NLR-Alb. Values above their cutoffs increased the mortality risk by 2.42, 5.6, 2.87, and 3.69-fold, respectively. In conclusion, NAR can better predict outcomes in dogs with AP than NLR. NLR-Alb is also superior to NLR but exhibits low specificity in identifying non-survivors. NPAR offers no prognostic advantage over other markers. Using these markers to predict mortality may improve treatment efficiency in dogs with AP.