Prognostic Nutritional Index and CRP/Albumin Ratio in Predicting Acute Pancreatitis Outcomes

Objectives: Acute pancreatitis (AP) remains a challenging condition with variable clinical outcomes. This study investigated the prognostic value of the C-reactive protein (CRP)/albumin ratio and the Prognostic Nutritional Index (PNI) in predicting disease severity and intensive care unit (ICU) admission in patients with AP.Materials and Methods: This retrospective study, approved by the Ethics Committee of Ankara Etlik City Hospital (28/02/2024, AEŞH-BADEK-2024-177), included 444 adults diagnosed with acute pancreatitis in the Internal Medicine Department of Ankara Etlik City Hospital. Disease severity was classified according to the Revised Atlanta criteria, and the CRP/albumin ratio and Prognostic Nutritional Index (PNI) were calculated from admission data. Receiver operating characteristic (ROC) analysis was performed to evaluate their predictive performance.Results: Among 444 patients, 340 (76.6%) had mild and 104 (23.4%) moderate-to-severe acute pancreatitis. The moderate-to-severe group had significantly higher CRP/albumin ratios (p < 0.001) and lower PNI scores (p < 0.001). ICU patients likewise showed elevated CRP/albumin ratios (p < 0.001) and reduced PNI (p < 0.001). ROC analysis showed that the CRP/albumin ratio (AUC = 0.698) and PNI (AUC = 0.806) predicted disease severity, with optimal cut-offs of 13.43 and 47.2, respectively. For ICU admission, PNI showed superior predictive power (AUC = 0.904) to the CRP/albumin ratio (AUC = 0.705).Conclusion: The CRP/albumin ratio and PNI are simple, cost-effective biomarkers for early risk stratification in acute pancreatitis. Both showed strong predictive value for disease severity and ICU need, with PNI demonstrating superior accuracy. These indices may support clinical decision-making, particularly in resource-limited settings.