C-Reactive Protein at 24 Hours after Hospital Admission may have Relevant Prognostic Accuracy in Acute Pancreatitis: A Retrospective Cohort Study

INTRODUCTION C-reactive protein (CRP) and Bedside Index for Severity in Acute Pancreatitis (BISAP) have been used in early risk assessment of patients with AP. OBJECTIVES We evaluated prognostic accuracy of CRP at 24 hours after hospital admission (CRP24) for in-hospital mortality (IM) in AP individually and with BISAP. MATERIALS AND METHODS This retrospective cohort study included 134 patients with AP from a Portuguese hospital in 2009-2010. Prognostic accuracy assessment used area under receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS Thirteen percent of patients had severe AP, 26% developed pancreatic necrosis, and 7% died during index hospital stay. AUCs for CRP24 and BISAP individually were 0.80 (95% confidence interval (CI) 0.65-0.95) and 0.77 (95% CI 0.59-0.95), respectively. No patients with CRP24 <60 mg/l died (P = 0.027; negative predictive value 100% (95% CI 92.3-100%)). AUC for BISAP plus CRP24 was 0.81 (95% CI 0.65-0.97). Change in NRInonevents (42.4%; 95% CI, 24.9-59.9%) resulted in positive overall NRI (31.3%; 95% CI, -36.4% to 98.9%), but IDInonevents was negligible (0.004; 95% CI, -0.007 to 0.014). CONCLUSIONS CRP24 revealed good prognostic accuracy for IM in AP; its main role may be the selection of lowest risk patients.