Value of C-reactive protein-albumin-lymphocyte index， C-reactive protein-to-lymphocyte ratio， and C-reactive protein-to-serum calcium ratio in evaluating the severity and prognosis of patients with acute pancreatitis

Jun XIA; Liang SUN; Jun WANG; Peng PENG

doi:10.12449/JCH251222

Volume 41 Issue 12

Dec. 2025

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Article Navigation > Journal of Clinical Hepatology > 2025 > 41(12): 2597-2606

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Value of C-reactive protein-albumin-lymphocyte index， C-reactive protein-to-lymphocyte ratio， and C-reactive protein-to-serum calcium ratio in evaluating the severity and prognosis of patients with acute pancreatitis

DOI: 10.12449/JCH251222

Jun XIA¹,
Liang SUN²,
Jun WANG¹,
Peng PENG^{1
,
,
,}

1.
Department of Emergency Medicine, The First Affiliated Hospital of Soochow University，Suzhou，Jiangsu 215006，China
2.
Department of General Surgery, The First Affiliated Hospital of Soochow University，Suzhou，Jiangsu 215006，China

Research funding:

National Natural Science Foundation of China (82103362)

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Corresponding author: PENG Peng， sdfyypp@163.com （ORCID： 0009-0009-0576-0942）
Received Date: 2025-06-18
Accepted Date: 2025-08-01
Published Date: 2025-12-25

Abstract

Abstract

Objective To investigate the association of C-reactive protein-albumin-lymphocyte （CALLY） index， C-reactive protein-to-lymphocyte ratio （CLR）， and C-reactive protein-to-serum calcium ratio （CCR） with the severity and prognosis of patients with acute pancreatitis （AP）， to construct a prognosis prediction model， and to provide a reference for clinical assessment of severity and prognosis. Methods A total of 407 AP patients who were diagnosed and treated in The First Affiliated Hospital of Soochow University from June 2021 to June 2024 were enrolled as subjects， and according to the 2012 revised edition of Atlanta classification standard and the prognosis within 6 months， the patients were divided into mild disease group with 146 patients， moderate disease group with 137 patients， and severe disease group with 124 patients， as well as into poor prognosis group with 54 patients and good prognosis group with 353 patients. Clinical data were collected from all subjects， and CALLY index， CLR， and CCR values were calculated. The independent samples t-test was used for comparison of continuous data between two groups， and a one-way analysis of variance was used for comparison between three groups； the chi-square test was used for comparison of categorical data between groups. A Pearson correlation analysis was used to investigate the correlation of CALLY index， CLR， and CCR with the severity and prognosis of AP patients， and the Cox regression analysis was used to identify the influencing factors for poor prognosis of AP patients. The Kaplan-Meier survival curve was used to analyze the influence of CALLY index， CLR， and CCR on the overall survival （OS） of AP patients； R software was used to construct a nomogram model for predicting poor prognosis of AP patients based on risk factors identified by the multivariate Cox regression analysis. The receiver operating characteristic （ROC） curve was plotted to analyze the value of each independent factor used alone or in combination in predicting the poor prognosis of AP patients. Results There were significant differences between the mild， moderate， and severe disease groups in Computed Tomography Severity Index， Bedside Index for Severity in Acute Pancreatitis （BISAP） score， Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ） score， blood urea nitrogen， serum lactic acid， serum amylase， serum lipase， CALLY index， CLR， and CCR， and there were also significant differences in these indicators between the good prognosis group and the poor prognosis group （all P<0.05）. The Pearson correlation analysis showed that CALLY index was negatively correlated with the severity and prognosis of AP （r_s =-0.134 and -0.280，both P<0.05）， while CLR and CCR were positively correlated with the severity and prognosis of AP （r_s =0.213 — 0.345，all P<0.05）. The Cox regression analysis confirmed that high BISAP score（HR=2.246，95%CI：1.412 — 3.570）， high APACHE Ⅱ score（HR=1.202，95%CI：1.089 — 1.327）， high serum amylase level（HR=1.004，95%CI：1.001 — 1.007），high serum lipase level（HR=1.005，95%CI：1.002 — 1.008）， low CALLY inde（HR=0.536，95%CI：0.397 — 0.724）， high CLR（HR=1.033，95%CI：1.011 — 1.055）， and high CCR （HR=1.144，95%CI：1.062 — 1.232）were independent risk factors for the poor prognosis of AP （all P<0.05）. The Kaplan-Meier survival curve analysis showed that the patients with low CALLY index had a shorter median OS than those with high CALLY index （Log-rank χ²=31.934， P<0.001）， and the patients with high CLR and CCR had a significantly shorter median OS than those with low CLR and CCR， respectively （Log-rank χ²=34.201 and 28.023， both P<0.001）. The nomogram model constructed based on the multivariate analysis showed excellent predictive efficiency， with an area under the ROC curve （AUC） of 0.977， which was significantly better than the AUC of each indicator used alone （P<0.05）， when the cut-off value is 0.107，the sensitivity and specificity of the nomogram model reached 0.963 and 0.898， respectively. Internal validation confirmed that the model had good stability， with a C-index of 0.954， and the decision curve analysis showed that it had satisfactory clinical applicability. Conclusion CALLY index， CLR， and CCR are correlated with the severity and prognosis of AP patients. High BISAP score， high APACHE II score， high serum enzyme level， low CALLY index， high CLR， and high CCR are independent risk factors for poor prognosis， and the nomogram model constructed based on multiple factors has high predictive efficiency and can achieve early accurate prediction of the prognosis of AP patients， thereby providing a practical tool for individualized intervention and dynamic risk assessment in clinical practice.
- Pancreatitis,
- Patient Acuity,
- Prognosis

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Value of C-reactive protein-albumin-lymphocyte index， C-reactive protein-to-lymphocyte ratio， and C-reactive protein-to-serum calcium ratio in evaluating the severity and prognosis of patients with acute pancreatitis

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Value of C-reactive protein-albumin-lymphocyte index， C-reactive protein-to-lymphocyte ratio， and C-reactive protein-to-serum calcium ratio in evaluating the severity and prognosis of patients with acute pancreatitis

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