Neutrophil-C-reactive protein index as a novel prognostic tool for acute pancreatitis in resource-constrained settings.

BACKGROUND

Acute pancreatitis (AP) requires early risk stratification, particularly in resource-limited settings. This study evaluates the Neutrophil× C-Reactive Protein (CRP) Index (NCI) as a biomarker for predicting severe AP (SAP) and in-hospital mortality.

METHODS

In this prospective cohort study, adult AP patients were enrolled consecutively at a tertiary hospital in Vietnam. Complete blood count and CRP levels were measured within 24 hours of admission. NCI was compared against other neutrophil-lymphocyte-CRP combinations and the Bedside Index for Severity in Acute Pancreatitis (BISAP). Prognostic performance was assessed using the area under the receiver operating characteristic curves (AUCs), and a Restricted Cubic Splines analysis explored the linear relationship between NCI and SAP risk. Internal and external validations were performed.

RESULTS

The study included 257, 83, and 121 patients in the training, internal, and external cohorts, respectively. Optimal NCI cut-off values were ≥1877 for SAP and ≥3180 for mortality. NCI showed a linear relationship with SAP risk ( P -values for non-linearity: 0.420-0.773). NCI predicted SAP with AUCs of 0.853, 0.897, and 0.844 across cohorts. It outperformed CLR (AUCs: 0.653-0.856) and NLR (AUCs: 0.719-0.844), with performance similar to neutrophil× CRP-to-lymphocyte ratio (AUCs: 0.832-0.898). For in-hospital mortality, NCI achieved AUCs of 0.824-0.902, comparable to BISAP (0.735-0.943), and outperformed other combinations. Good calibration and clinically relevant post-test probabilities were observed.

CONCLUSIONS

NCI is a simple, accessible, and effective biomarker for early risk stratification in SAP and in-hospital mortality, particularly in resource-limited settings. Its reliance on routine blood tests supports its practical use for timely triage and management of AP.