Early temporal dynamics of the phosphorus to calcium ratio for severity prediction in acute pancreatitis: A retrospective cohort study

Öz

Backgorund and Aims: Acute pancreatitis ranges from mild disease to severe forms associated with organ failure and mortality. Early risk stratification is essential, yet current scoring systems may not fully reflect early metabolic alterations. While hypocalcemia is a recognized severity marker, the prognostic role of phosphorus remains unclear. This study evaluated whether early phosphorus-to-calcium ratio changes within 48 hours predict disease severity in acute pancreatitis. Materials and Method: This retrospective single-center study included adults hospitalized with acute pancreatitis between January 2023 and December 2025. Phosphorus-to-calcium ratio was calculated from routinely recorded serum phosphorus and calcium levels at admission, 24, and 48 hours. Severity was defined according to the Revised Atlanta Classification. Multivariable logistic regression and receiver operating characteristic analyses were performed. Results: A total of 182 patients were included [mean age 56.8 ± 15.9 years; 100 male (54.9%)]. Mild acute pancreatitis occurred in 140 patients (76.9%), moderately severe in 32 (17.6%), and severe in 10 (5.5%). Persistent organ failure occurred in 12 (6.6%), intensive care unit admission in 14 (7.7%), and in-hospital mortality in 3 patients (1.6%). Phosphorus-to-calcium ratio values increased during the first 48 hours and were higher in moderate-to-severe/severe disease. After adjustment for age, creatinine, C-reactive protein level, and clinical severity score, the 48-hour change in the phosphorus-to-calcium ratio remained independently associated with severity (Odds ratio 1.64, 95% confidence interval 1.14 - 2.36, p = 0.008). Conclusion: Early phosphorus-to-calcium ratio dynamics may serve as a simple adjunct biomarker to existing clinical scores for predicting severity in acute pancreatitis.

Anahtar Kelimeler

• Acute pancreatitis
• biomarkers
• calcium
• phosphorus

Akut pankreatitte şiddet öngörüsü için fosfor/kalsiyum oranının erken zamansal dinamikleri: Retrospektif kohort çalışması

Öz

Giriş ve Amaç: Akut pankreatit, hafif seyirli hastalıktan organ yetmezliği ve mortalite ile ilişkili ağır formlara kadar değişebilen bir klinik tabloya sahiptir. Erken risk sınıflandırması önemlidir; ancak mevcut skorlama sistemleri erken metabolik değişiklikleri tam olarak yansıtmayabilir. Hipokalsemi bilinen bir şiddet belirteci olmakla birlikte, fosforun prognostik rolü net değildir. Bu çalışmada, ilk 48 saat içindeki fosfor-kalsiyum oranı değişimlerinin hastalık şiddetini öngörüp öngöremeyeceği değerlendirildi. Gereç ve Yöntem: Bu retrospektif tek merkezli çalışmaya Ocak 2023 ile Aralık 2025 tarihleri arasında akut pankreatit nedeniyle hastaneye yatırılan erişkin hastalar dahil edildi. Fosfor-kalsiyum oranı, başvuru anında ve 24. ile 48. saatlerde ölçülen serum fosfor ve kalsiyum düzeylerinden hesaplandı. Hastalık şiddeti Revize Atlanta Sınıflaması’na göre tanımlandı. Çok değişkenli lojistik regresyon ve alıcı çalışma özelliği eğrisi analizleri yapıldı. Bulgular: Toplam 182 hasta çalışmaya dahil edildi [ortalama yaş 56.8 ± 15.9 yıl; 100 erkek (%54.9)]. Hastaların 140’ında (%76.9) hafif, 32’sinde (%17.6) orta-ağır ve 10’unda (%5.5) ağır akut pankreatit saptandı. Persistan organ yetmezliği 12 hastada (%6.6), yoğun bakım ünitesi yatışı 14 hastada (%7.7) ve hastane içi mortalite 3 hastada (%1.6) görüldü. Fosfor-kalsiyum oranı ilk 48 saat içinde artış gösterdi ve orta-ağır/ağır hastalıkta daha yüksekti. Yaş, kreatinin, C-reaktif protein düzeyi ve klinik şiddet skoru için yapılan düzeltme sonrasında, 48. saatteki fosfor-kalsiyum oranı değişimi hastalık şiddeti ile bağımsız olarak ilişkili bulundu (risk oranı 1.64; %95 güven aralığı 1.14 - 2.36; p = 0.008). Sonuç: Erken dönem fosfor-kalsiyum oranı dinamikleri, akut pankreatitte hastalık şiddetini öngörmede mevcut klinik skorlara tamamlayıcı basit bir biyobelirteç olarak kullanılabilir.

Anahtar Kelimeler

• Akut pankreatit
• biyobelirteçler
• fosfor
• kalsiyum

Kaynakça

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