Abstract

Background: Early identification of disease severity in acute pancreatitis (AP) remains a major clinical challenge. The neutrophil percentage-to-albumin ratio (NPAR) is a novel inflammatory index that reflects systemic inflammation, but evidence regarding its role in predicting AP severity remains limited. This study aimed to evaluate the association between admission NPAR and AP severity and to compare its predictive performance with other inflammatory indices. Methods: This retrospective study included 261 patients with AP. NPAR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the systemic immune inflammation index (SII) were calculated using laboratory parameters obtained at hospital admission. Disease severity was assessed according to the revised Atlanta classification and the Bedside Index for Severity in Acute Pancreatitis (BISAP) score. Receiver operating characteristic (ROC) curve analysis was performed to compare predictive performance, and logistic regression analyses were used to identify independent predictors of disease severity. Results: Admission NPAR values were significantly higher in patients with moderately severe/severe AP according to the revised Atlanta classification and in patients with BISAP scores ≥ 3 (both p < 0.001). Among the evaluated inflammatory indices, NPAR demonstrated the highest predictive performance for disease severity according to both the revised Atlanta classification (AUC: 0.808) and BISAP score (AUC: 0.841). In multivariate logistic regression analysis, admission NPAR remained independently associated with AP severity (OR: 1.279, 95% CI: 1.174–1.393, p < 0.001). Admission NPAR levels were also significantly higher in non-survivors than in survivors (p = 0.017). Conclusions: Admission NPAR appears to be a simple, inexpensive, and readily available inflammatory index associated with disease severity in patients with AP. These findings suggest that NPAR may serve as a useful adjunctive tool for early risk stratification. However, larger prospective multicenter studies are required to validate these findings and confirm the proposed admission cut-off value before routine clinical implementation.

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