The predictive value of the prealbumin-to-fibrinogen ratio in patients with acute pancreatitis

Objective: Early identification of severe acute pancreatitis (SAP) progression is important in acute pancreatitis (AP) treatment. The Ranson, APACHE II and CTSI systems are difficult to use and exhibit limited predictive value. Prealbumin and fibrinogen are acute phase reactants generally used to assess the nutritional statuses and coagulation functions of AP patients, respectively. Here, we explored the value of the combination of these two markers for evaluating AP severity and prognosis. Methods: One hundred and sixty-nine AP patients, including mild AP (MAP) (n = 101) and severe AP (SAP) patients (n = 68), were enrolled. Their Ranson, APACHE II and CTSI scores, routine laboratory test results, and prealbumin and fibrinogen levels were determined after admission. Multivariate regression analysis was performed to determine the independent predictors of AP severity. ROC curves were generated to determine the suitabilities of prealbumin and fibrinogen levels and the above-mentioned scores for SAP prediction. Results: The SAP patients exhibited higher scores, white blood cell counts, CRP and fibrinogen levels but lower calcium, prealbumin levels and prealbumin/fibrinogen ratio than the MAP patients (p < 0.05). The multivariate regression analysis demonstrated that the prealbumin/fibrinogen ratio was a good predictor of severity and outperformed CRP. The prealbumin/fibrinogen ratio was correlated with CRP, hospitalisation length and complication occurrence in SAP. The ROC curve analyses showed that the prealbumin/fibrinogen ratio exhibited superior sensitivity, specificity, PPV and NPV for SAP prediction over the scoring systems. With a cut-off of 31.70 mg/g, the sensitivity, specificity, PPV and NPV were 76.5%, 94.1%, 89.6% and 85.6%, respectively. Conclusions: The prealbumin/fibrinogen ratio is a promising predictor of AP severity and prognosis.