An early prognostic marker for determining disease severity in acute cholangitis: CRP/albumin ratio

INTRODUCTION: This study was undertaken to investigate the importance of the CRP/albumin ratio (CAR) as an early prognostic marker for determining disease severity in acute cholangitis.
METHODS: A total of 366 patients aged >18 years diagnosed with acute cholangitis were included in the study. Acute cholangitis severity was determined according to the 2018 Tokyo criteria.
RESULTS: The study population consisted of 49.2% patients with mild, 24.6% moderate, and 26.2% severe acute cholangitis. The cut-off CAR value for predicting moderate risk compared to the mild risk group was found to be >1 with 73.3% sensitivity and 76.7% specificity (AUC±SE: 0.785±0.03; +PV: 61.1%, -PV: 85.2%; p<0.001). The CAR cut-off value for predicting severe risk compared to the moderate risk group was found to be >2.9 with 71.9% sensitivity and 71.1% specificity (AUC±SE: 0.788±0.03; +PV: 72.6%, -PV: 70.3%; p<0.001). The CAR cut-off value for predicting admission to the intensive care unit (ICU) was >2.5 with 77.4% sensitivity and 74.6% specificity (AUC±SE: 0.803±0.03; +PV: 43.1%, -PV: 90.1%; p<0.001). The CAR cut-off value for predicting mortality was >2.8 with 100% sensitivity and 74.9% specificity (AUC±SE: 0.890±0.03; +PV: 19.5%, -PV: 100%; p<0.001). Compared to its components, the CAR was found to exhibit superior diagnostic performance in predicting moderate or severe risk, ICU admission, and mortality.

DISCUSSION AND CONCLUSION: We found that the CAR is a good prognostic marker in determining the severity of acute cholangitis in the early period.