The APRI-Based Multi-Marker Score: A Practical Model for Predicting Organ Failure in Acute Pancreatitis

Abstract Background Acute pancreatitis (AP) is a heterogeneous disease with variable severity and clinical outcomes. Early prediction of persistent organ failure (POF), a major determinant of a poor prognosis, remains challenging. Aspartate aminotransferase (AST) levels are included in severity scoring systems such as the Ranson and Glasgow Imrie scores, while thrombocytopenia occurs frequently in critical diseases and correlates with disease severity. The aminotransferase-platelet ratio index (APRI score) is traditionally used as a marker of liver fibrosis, but it may have a broader prognostic utility. This study evaluated the potential of combining the APRI score with other routine biomarkers (procalcitonin [PCT], lipase, urea, and creatinine) for early prediction of POF in patients with AP. Methods In a single-centre retrospective study involving 149 patients with AP, the APRI score and multiple biochemical markers were measured at admission. Logistic regression assessed the predictive value of POF and associated complications. The CombiROC method evaluated combinations of biomarkers to optimise prediction models. Cut-off values to build a composite score were determined by ROC analysis. Results Higher APRI scores were significantly associated with POF. APRI score alone showed moderate predictive ability (AUC = 0.68) and predicted gallstone-associated AP (AUC = 0.717). Combining the APRI score with the other biomarkers improved the sensitivity and specificity for the prediction of POF. A composite scoring system (0–10) with a cut-off ≥ 7 identified a high-risk group with 100% specificity, 48.4% sensitivity, 100% positive predictive value, and 94.8% negative predictive value. Conclusion A simple multi-marker score that incorporates APRI and routine biomarkers substantially improves early prediction of POF in AP, potentially guiding clinical risk stratification and management.