Comparative Evaluation of Inflammatory, Nutritional and Composite Indices in Acute Pancreatitis

Aim: Early identification of patients with acute pancreatitis (AP) who are at risk of complicated disease and the need for intensive care unit (ICU) admission remains a major clinical challenge during emergency department evaluation and during inpatient follow-up.Easily accessible laboratory-based inflammatory and nutritional indices may provide practical tools for early risk stratification and clinical decision-making. Materials and Methods:In this retrospective cohort study, 348 patients hospitalized with AP were evaluated.Inflammatory, nutritional, and composite indices derived from routine laboratory parameters obtained at hospital admission were calculated.Their associations with clinical outcomes were analyzed.Results: Complicated pancreatitis occurred in 40.2% of patients and 10.3% of patients required ICU admission.Several inflammation-based indices, including the neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index and C-reactive protein-to-albumin ratio (CAR), were significantly associated with adverse outcomes.In multivariable analyses, CAR and the C-reactive protein-albumin-lymphocyte index (CALLY) remained independently associated with both complicated pancreatitis and the need for ICU admission.In ROC analysis, CALLY demonstrated the highest discriminative performance for predicting ICU requirement (area under the curve =0.808) with an optimal cut-off of0.05.Composite prognostic scores, including the Naples Prognostic score and Glasgow Prognostic score, were associated with outcomes in unadjusted analyses, but did not retain independent prognostic value. Conclusion:Inflammation-based indices derived from routine laboratory tests particularly CAR and CALLY are associated with complicated pancreatitis and the need for ICU admission in patients with AP.Given their simplicity, low cost and availability at hospital admission, these indices may support early risk stratification and clinical management.Prospective multicenter studies are warranted to validate these findings.