In acute pancreatitis patients CRP-albumin ratio, neutrophil-lymphocyte ratio and glucosis-lymphocyte ratio with investigation of the relationship between the severity of the disease, in hospital mortality and duration of stay in hospital

Objective: In our study, the role of CRP-Albumin ratio, Neutrophil-Lymphocyte ratio, Glucose-Lymphocyte ratio in predicting the severity of the disease, in hospital mortality and hospital stay were investigated in patients hospitalized with the diagnosis of acute pancreatitis in Aydın Adnan Menderes University Practice and Research Hospital. It is aimed to determine the superiority of these parameters to each other. Material and Methods: Our study was constructed retrospectively. 200 patients with acute pancreatitis who were hospitalized between 1 January 2012 and 1 January 2022 in Aydın Adnan Menderes University Practice and Research Hospital were included in the study. Pregnant patients, patients with active malignancies and patients under 18 years of age were excluded from the study. It is planned to examine the relationship between CRP-albumin ratio, Neutrophil-lymphocyte ratio (NLR), Glucose-lymphocyte ratio (GLR) at the time of admission and the severity of the disease, in hospital mortality and duration of hospital stay. The revised Atlanta classification published in 2012 and the Balthazar Severity score based on abdominal computed tomography were used to rate the severity of acute pancreatitis. The measured data of the patients were recorded from the hospital information system and patient files. Data analysis and statistical evaluation was done with SPSS version 26.0 program. p<0.05 value was accepted as significant. Findings: A total of 200 patients diagnosed with acute pancreatitis, 80 (%40) male and 120 (%60) female, were included in our study. The mean age of the female patients was 66.93±17.88, and the mean age of the male patients was 59.41±19.38 years. 126 (63%) patients were 60 years or older. Hypertension (HT) was the most common with 93 (46.5%) patients when comorbidities were examined. 68 (34%) patients had no additional disease. In the etiological examination, the number of patients with non-biliary acute pancreatitis was 89 (44.5%) and the number of patients with biliary acute pancreatitis was 111 (55.5%). According to the revised Atlanta Classification, 52 (26%) patients were mild, 79 (39.5%) moderately severe, 69 (34.5%) patients were severe; According to the Balthazar Severity Score, 150 (75%) patients were evaluated as mild, 38 (19%) patients as moderate, 12 (6%) patients as severe acute pancreatitis. The number of patients with local complications was 137 (68.5%), the number of patients with systemic complications was 27 (13.5%), and the number of patients with organ failure was 42 (21%). It was observed that the patients were hospitalized for an average of 9.9±7.6 days and 16 (8%) patients died. A significant positive correlation was found between CRP/Albumin, NLR, GLR with Atlanta classification (p<0,001), Balthazar Severity score (p<0,001; p<0,001; p=0,012). CRP/Albumin (p<0.001), NLR (p<0.001), GLR (p=0.001) were found to be statistically significant in differentiating severe AP from moderate and mild AP according to the Atlanta classification. According to ROC analysis, 79.7% sensitivity and 83.5% specificity for CRP/Albumin value, 76.8% sensitivity and 64.9% specificity for NLR value, 71% sensitivity and 51.9% specificity for GLR value were obtained. CRP/Albumin (p<0.001) was found to be statistically significant in differentiating severe AP from moderate and mild AP according to the Balthazar severity score, while NLR and GLR were statistically insignificant. According to ROC analysis, 75% sensitivity and 85.1% specificity were obtained for the CRP/Albumin value. The CRP/Albumin and NLR levels of the patients who died were significantly higher than those who survived (p<0.001; p=0.027). No significant correlation was found between GLR and in-hospital mortality. According to ROC analysis, 68.8% sensitivity and 79.9% specificity for CRP/Albumin value, 87.5% sensitivity and 57.6% specificity for NLR value were obtained. A significant positive correlation was found between CRP/Albumin, NLR, GLR and length of hospital stay (p<0.001; p=0.003; p=0.015). CRP/Albumin, NLR and GLR values increased as the duration of hospital stay increased. Conclusion: As a result of our study, CRP/albumin value was found to be a statistically superior biomarker to NLR and GLR in differentiating severe acute pancreatitis patients from moderate and mild acute pancreatitis patients according to the Atlanta Classification and Balthazar severity score, in predicting in-hospital mortality and duration of hospital stay (p<0,001). We think that these easily accessible, inexpensive and simple to calculate parameters can be used to predict the morbidity and mortality of the disease in patients with acute pancreatitis. More comprehensive, prospective and multicenter studies to be conducted will guide in predicting the prognosis of the disease. Key Words: Acute Pancreatitis, CRP-Albumin Ratio, Neutrophil-Lymphocyte Ratio, Glucose-Lymphocyte Ratio, Atlanta Classification, Balthazar Severity Score, Mortality , Duration of Hospital Stay