Acute pancreatitis is an inflammatory condition that may vary from a mild, self-limiting course to a fulminant stage associated with multiple organ failure and high fatality (1). Clinically, it manifests in two major forms: edematous pancreatitis, which accounts for nearly 80% of cases, and acute necrotizing pancreatitis, observed in about 20% of patients. The mortality rate in edematous pancreatitis is relatively low, averaging around 1%, whereas necrotizing pancreatitis carries a significantly higher risk, with mortality ranging from 10% to 20% (2). Patients with mild disease often respond well to vigorous fluid resuscitation and supportive therapy, while those with severe acute pancreatitis may require nutritional support and intensive non-operative management (3). Severe acute pancreatitis is generally described in two phases: the early phase (within the first two weeks) characterized by pancreatic inflammation and necrosis, often complicated by systemic inflammatory response syndrome (SIRS), and the late phase (after two weeks) involving persistent organ dysfunction, infected pancreatic necrosis, or fluid collections that may progress to sepsis and death (4). Multiple organ dysfunction syndrome (MODS) is the leading cause of mortality, with death rates ranging from 30% to 100% among those affected (5). Notably, only about 50% of patients with pancreatic necrosis develop organ failure, and respiratory failure remains the most common manifestation (6). Increasing insights into the role of pro- and anti-inflammatory cytokines have supported the development of targeted anti-inflammatory therapies. Among currently available tools, C-reactive protein (CRP) remains the most reliable marker for predicting severity, especially when measured 48 to 72 hours after the onset of pain. Alongside CRP, IL-6 levels, Ranson’s criteria, and APACHE II scores serve as strong predictors of severe acute pancreatitis (7). However, studies comparing CT scans, Ranson’s score, APACHE II, and serum markers individually have shown limited predictive value when applied in isolation. The present study is therefore designed to predict the severity of acute pancreatitis using available clinico-biochemical parameters, to assess disease severity in relation to serum CRP, to evaluate the prognostic significance of serum amylase, APACHE II score, and CRP, and to predict overall outcomes of acute pancreatitis with respect to serum CRP.

The present study was conducted on patients who attended the Department of General Surgery with clinical features suggestive of acute pancreatitis. These patients were evaluated in detail, and those fulfilling the diagnostic criteria were enrolled. This was an observational study carried out at the PES Institute of Medical Sciences and Research. The study was undertaken in a hospital-based setting, allowing access to both emergency and elective admissions with acute pancreatitis. The research was conducted over a period of 20 months, from November 2020 to June 2022, during which all eligible patients meeting the inclusion criteria were consecutively enrolled. The study population comprised patients presenting with suspected acute pancreatitis. A purposive sampling method was used to select participants, ensuring that only clinically relevant and diagnostically confirmed cases were included. In total, 84 patients were studied. Inclusion and Exclusion Criteria Patients aged 25 years and above, of either sex, and diagnosed with acute pancreatitis were included in the study. Exclusion criteria were applied to eliminate potential confounding factors. These included patients below 25 years of age, patients with a diagnosis of chronic pancreatitis, and those unwilling or refusing to provide consent. Diagnostic Criteria The diagnosis of acute pancreatitis was established through a combination of clinical evaluation and biochemical investigations. An elevated serum amylase level above the upper reference limit was considered a primary diagnostic marker. Radiological investigations were also performed for confirmation, which included plain X-ray abdomen, abdominal ultrasonography (USG), and contrast-enhanced computed tomography (CECT) scan. Investigations and Materials Used All patients underwent a comprehensive series of investigations to assess the diagnosis and severity of acute pancreatitis: • Biochemical parameters included measurement of serum C-reactive protein (CRP), serum amylase, and serum lipase. These were critical in both diagnosis and prognostication. • Blood investigations consisted of a complete blood count (CBC), serum electrolytes, serum creatinine, and blood urea levels. In addition, arterial blood gas (ABG) analysis was performed to evaluate acid-base status and systemic involvement. • Urine analysis was undertaken as part of routine biochemical assessment. • Radiological investigations played an important role in confirming the diagnosis and assessing disease severity. These included plain abdominal X-ray, ultrasonography of the abdomen, and contrast-enhanced CT scan (CECT), the latter being particularly useful in identifying necrosis and local complications. Statistical Analysis All data collected were compiled and systematically analyzed. Descriptive statistics such as mean, standard deviation, and percentage distribution were applied to summarize patient demographics, clinical features, and biochemical parameters. To evaluate the relationship between prognostic markers (such as CRP, serum amylase, and APACHE II score) and severity of acute pancreatitis, appropriate comparative statistical tests were used, including the Chi-square test for categorical variables and Student’s t-test/ANOVA for continuous variables where applicable. A p-value of <0.05 was considered statistically significant. Data analysis was performed using standard statistical software.

Table 1: Distribution of Study Subjects According to Age and Gender Variable Category No. of Subjects Percentage Age (years) <30 16 19.1% 31–40 34 40.5% 41–50 22 26.2% 51–60 6 7.1% >61 6 7.1% Gender Male 72 85.7% Female 12 14.3% Total 84 100% Among the 84 patients, most were 31–40 years (40.5%), followed by 41–50 years (26.2%) and <30 years (19.1%); only small proportions were 51–60 years and >61 years (each 7.1%). The cohort was predominantly male (72/84; 85.7%), with females comprising 14.3% (12/84). Overall, the sample reflects a mainly middle-aged, male population. Table 2: Distribution of Study Subjects According to Serum Amylase and Serum CRP Parameter Category No. of Subjects Percentage Serum Amylase (IU/L) <1000 70 83.3% >1000 14 16.7% Serum CRP (mg/L) <150 34 40.5% >150 50 59.5% Total 84 100% Among 84 patients, serum amylase was <1000 IU/L in 70 (83.3%) and >1000 IU/L in 14 (16.7%), indicating most had moderate enzyme elevations. In contrast, serum CRP was >150 mg/L in 50 (59.5%) and <150 mg/L in 34 (40.5%), showing that a majority had substantial inflammatory activity. Taken together, while enzyme levels were usually below 1000 IU/L, the higher proportion with CRP >150 mg/L suggests many patients carried a higher inflammatory burden and potential for greater severity. The pie chart shows a near-even split in severity by APACHE II: 46/84 (54.8%) scored >8, while 38/84 (45.2%) scored <8. This means just over half of the cohort fell into a higher-risk category, suggesting a substantial burden of patients needing closer monitoring and early, aggressive supportive care. In your dataset, higher APACHE II also tracked with CRP >150 mg/L, reinforcing that systemic inflammation and physiologic derangement clustered together. Patients with scores <8 generally had a more favorable short-term risk but still required routine observation. TABLE 3: Mean and SD of study subjects according to Variable Variable Mean Standard deviation Min Max AGE (years) 39.9 10.2 26 68 SERUM CRP 140.5 24.1 68 168 SERUM AMYLASE 503.9 347.1 126 1520 APACHE II SCORE 8.8 3.0 4 18 The cohort was relatively young to middle-aged (mean age 39.9±10.2 years; range 26–68). Inflammation was substantial: mean CRP 140.5±24.1 mg/L (range 68–168), close to the 150 mg/L severity threshold, suggesting many patients were at higher risk early on. Mean serum amylase 503.9±347.1 IU/L (range 126–1520) showed wide variability, consistent with its role in diagnosis rather than severity grading. The average APACHE II score was 8.8±3.0 (range 4–18), sitting around the >8 risk cut-off and in line with your finding that just over half the patients were in a higher-risk category. Overall, dispersion and ranges indicate heterogeneous disease intensity across the sample. Table 4: Chi-Square Association between Serum CRP and Other Parameters Comparison Groups Compared χ² Value p-Value Significance Key Findings Serum Amylase vs Serum CRP <1000 vs >1000 IU/L × <150 vs >150 mg/L 11.424 0.001 Significant All patients with CRP <150 mg/L had amylase <1000 IU/L APACHE II Score vs Serum CRP <8 vs >8 × <150 vs >150 mg/L 5.775 0.016 Significant 70% of patients with CRP <150 mg/L had APACHE II >8 Serum CRP vs APACHE II Score <150 vs >150 mg/L × <8 vs >8 5.775 0.016 Significant Higher CRP (>150) associated with APACHE II >8 Serum CRP vs Serum Amylase <150 vs >150 mg/L × <1000 vs >1000 IU/L 11.424 0.001 Significant Higher CRP (>150) associated with amylase >1000 IU/L The chi-square tests show that serum CRP meaningfully relates to other severity measures. First, CRP vs amylase: the association is strong (χ²=11.424; p=0.001); all patients with CRP <150 mg/L had amylase <1000 IU/L, and higher CRP was linked to amylase >1000 IU/L. Second, CRP vs APACHE II: there is a significant relationship (χ²=5.775; p=0.016), but in this dataset the pattern is inverse—about 70% of patients with CRP <150 mg/L had APACHE II >8, whereas a smaller proportion of those with CRP >150 mg/L crossed that threshold. This discrepancy likely reflects timing effects (CRP peaks at ~48–72 h, APACHE may be calculated earlier) and sample size; interpretation should consider when each test was obtained and, ideally, repeat measurements at 48 h. Overall, CRP tracks biochemically with amylase and shows a significant, timing-sensitive association with APACHE II (Table 4). Table 5: Chi-Square Association between Serum Amylase and APACHE II Score Comparison Groups Compared χ² Value p-Value Serum Amylase vs APACHE II Score (Table 16) <1000 vs >1000 IU/L × <8 vs >8 1.884 0.170 APACHE II Score vs Serum Amylase (Table 19) <8 vs >8 × <1000 vs >1000 IU/L 1.884 0.170 The chi-square tests show no significant association between serum amylase category and APACHE II severity (χ²=1.884, p=0.170 in both orientations). In other words, whether amylase was <1000 or >1000 IU/L did not differ meaningfully between patients with APACHE II <8 vs >8. This supports the view that amylase is useful for diagnosis, not prognosis. The null finding may also reflect timing of sampling, biological variability, and reduced power from dichotomizing both variables; analyzing continuous values or using regression could test this relationship more sensitively (Table 5).

Acute pancreatitis (AP) is a heterogeneous disease with outcomes ranging from mild, self-limiting inflammation to severe illness characterized by persistent organ failure and infected necrosis. The Revised Atlanta Classification (2012) emphasizes that AP has two distinct phases: an early phase, where systemic inflammatory response and risk of organ failure dominate, and a late phase, where local complications are more prominent. Severe AP is specifically defined by persistent organ failure lasting longer than 48 hours, making early and accurate risk stratification crucial for determining the appropriate level of care, monitoring, and resource allocation (8). In the present cohort of 84 patients, most were middle-aged men (85.7%), with favorable outcomes 94% were discharged, and the in-hospital mortality rate was 2.4%. These findings are consistent with modern series, where overall mortality in unselected AP patients remains around 1–3%, though the risk increases substantially in severe or necrotizing cases (9). Importantly, enzyme levels showed poor prognostic value: 83% of patients had serum amylase <1000 IU/L, and amylase elevation showed no significant association with APACHE II scores (χ²=1.884; p=0.170). This reflects current understanding and guidelines, which state that although elevated amylase or lipase confirms diagnosis, the degree of elevation does not stratify severity and is therefore excluded from modern prognostic tools (10). In contrast, C-reactive protein (CRP) demonstrated meaningful prognostic correlation: CRP >150 mg/L was associated with both higher amylase levels (χ²=11.424; p=0.001) and higher APACHE II scores (χ²=5.775; p=0.016). Numerous studies have validated CRP, particularly at ~48 hours after symptom onset, as a reliable severity marker, with a widely used threshold of 150 mg/L showing a sensitivity of ~80% and specificity of ~76% for predicting severe AP (11, 12). Though alternative cut-offs (such as ≥190 mg/L or a >90 mg/L rise within 48 hours) have been proposed, the 150 mg/L threshold remains the most practical because of its simplicity and universal availability. The APACHE II score also provided valuable prognostic information: more than half of the cohort (54.8%) had scores >8, and higher CRP values clustered with higher APACHE II, reinforcing the association between systemic inflammation and physiologic derangement. Prior research consistently shows that APACHE II has good discriminatory power for mortality, and its predictive value improves when recalculated at 24–48 hours rather than relying on admission scores alone (13). Alongside APACHE II, the BISAP score has been validated as a simpler alternative for early bedside assessment, with similar predictive accuracy for mortality (AUC ~0.82 for BISAP vs. ~0.83 for APACHE II) (14). Together, these findings suggest a pragmatic pathway for risk stratification in clinical practice: using BISAP or APACHE II on admission, repeating APACHE II scoring at 24–48 hours, and measuring CRP at around 48 hours. Combining these tools allows clinicians to identify high-risk patients who may require monitored or intensive care, early enteral feeding, and escalation of supportive therapy. While this study’s strengths include systematic data collection and statistical testing of biomarker associations, limitations such as its single-center design, modest sample size, purposive sampling, variable timing of CRP/score assessments, and absence of etiology stratification or Atlanta-based severity categories limit external comparability.

In conclusion, this cohort reaffirms that CRP ≥150 mg/L at ~48 h and APACHE II >8 reliably reflect greater disease severity, whereas amylase elevation does not. Mortality rates and discharge outcomes were consistent with global benchmarks. A practical approach in routine care is to combine early clinical scores with CRP measurement to refine prognosis and guide management decisions. Future multicenter studies with standardized biomarker timing, etiologic stratification, and application of Atlanta criteria are needed to validate combined models such as BISAP + CRP or APACHE II + CRP for improved calibration, discrimination, and real-world clinical utility.

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