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

Int J Surg. 2026 Feb 1;112(2):3297-3311. doi: 10.1097/JS9.0000000000003846. Epub 2025 Oct 30.

Abstract

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.

Keywords: BISAP; C-reactive protein; low-resource setting; neutrophil; prognostic biomarker; severe acute pancreatitis.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Biomarkers / blood
  • C-Reactive Protein* / analysis
  • C-Reactive Protein* / metabolism
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Neutrophils* / metabolism
  • Pancreatitis* / blood
  • Pancreatitis* / diagnosis
  • Pancreatitis* / mortality
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Vietnam

Substances

  • C-Reactive Protein
  • Biomarkers