Akut Pankreatit Sonuçlarını Tahmin Etmede Prognostik Beslenme İndeksi ve CRP/Albümin Oranı

Abstract

Amaç: Akut pankreatit (AP), değişken klinik sonuçlara sahip zorlu bir hastalık olmaya devam etmektedir. Bu çalışma, AP hastalarında hastalık şiddetini ve yoğun bakım ünitesi (YBÜ) yatışını öngörmede C-reaktif protein (CRP)/albümin oranı ile Prognostik Nütrisyonel İndeks’in (PNI) prognostik değerini araştırmayı amaçlamaktadır. Gereç ve Yöntem: Bu retrospektif çalışma, Ankara Etlik Şehir Hastanesi İç Hastalıkları Kliniği’nde akut pankreatit tanısı alan 444 erişkin hastayı içermektedir. Hastalık şiddeti, Revize Atlanta Kriterleri’ne göre sınıflandırılmıştır. CRP/albümin oranı ve PNI, başvuru anındaki laboratuvar verilerinden hesaplanmış; alıcı işletim karakteristik (ROC) analizi ile prediktif performansları değerlendirilmiştir. Bulgular: Toplam 444 hastanın 340’ı (%76,6) hafif AP, 104’ü (%23,4) orta-ağır AP grubundaydı. Orta-ağır grupta CRP/albümin oranı anlamlı olarak daha yüksek (p < 0,001) ve PNI skorları anlamlı olarak daha düşüktü (p < 0,001). YBÜ’ye kabul edilen hastalarda da CRP/albümin oranı yüksek (p < 0,001) ve PNI düşük (p < 0,001) bulundu. ROC analizi, CRP/albümin oranının (AUC = 0,698) ve PNI’nın (AUC = 0,806) hastalık şiddetini öngörebildiğini ve optimal kesim değerlerinin sırasıyla 13,43 ve 47,2 olduğunu gösterdi. YBÜ yatışı için PNI, CRP/albümin oranına (AUC = 0,705) kıyasla daha güçlü prediktif yeteneğe sahipti (AUC = 0,904). Sonuç: CRP/albümin oranı ve PNI, akut pankreatitte erken risk sınıflandırması için erişilebilir ve düşük maliyetli biyo-belirteçlerdir. Her iki parametre de hastalık şiddeti ve YBÜ gereksinimi açısından güçlü prediktif değer göstermiş; PNI, yoğun bakım ihtiyacını belirlemede daha üstün doğruluk sağlamıştır. Bu indeksler, özellikle kaynakların kısıtlı olduğu ortamlarda klinik kararın doğruluğunu destekleyebilir.

Keywords

• Akut pankreatit
• CRP/albümin oranı
• Prognostik Nutrisyonel İndeks
• Revize Atlanta Sınıflaması
• yoğun bakım ünitesi

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

Abstract

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.

Keywords

• Acute pancreatitis
• CRP/albumin ratio
• Prognostic Nutritional Index
• Revised Atlanta Classification
• intensive care unit

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