{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T15:29:15Z","timestamp":1790090955146,"version":"4.0.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute pancreatitis (AP) is a heterogeneous inflammatory disease, with \u223c20% of patients progressing to moderate-to-severe (MSAP) or severe AP (SAP), conditions associated with high mortality. Early risk stratification is therefore critical. This study systematically evaluated and compared 12 inflammatory biomarkers for predicting AP severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort included 1,981 hospitalized AP patients (January 2018-December 2023). According to the revised Atlanta criteria, patients were classified into mild AP (MAP,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,058) and MSAP\/SAP (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009923) groups. Twelve inflammatory indices\u2014monocyte-to-lymphocyte ratio (MLR), lymphocyte-to-monocyte ratio (LMR), C-reactive protein-to-albumin ratio (CAR), C-reactive protein-albumin-lymphocyte index (CALLY), C-reactive protein-to-calcium ratio (CCR), C-reactive protein-to-lymphocyte ratio (CLR), red cell distribution width-to-albumin ratio (RDW\/Alb), neutrophil-to-albumin ratio (NAR), systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)\u2014were calculated. A multivariate logistic regression model adjusted for 28 covariates. ROC curves assessed predictive performance; restricted cubic splines (RCS) explored nonlinear relationships; and threshold effect analysis was conducted for the highest-performing biomarker.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the fully adjusted model, nine biomarkers were significantly associated with MSAP\/SAP risk: MLR (OR\u2009=\u20091.29, 95%CI: 1.15\u20131.45), LMR (OR\u2009=\u20090.75, 95%CI: 0.66\u20130.85), CAR (OR\u2009=\u20093.82, 95%CI: 3.18\u20134.64), CALLY (OR\u2009=\u20090.56, 95%CI: 0.49\u20130.64), CCR (OR\u2009=\u20094.84, 95%CI: 3.98\u20135.96), CLR (OR\u2009=\u20092.12, 95%CI: 1.84\u20132.46), RDW\/Alb (OR\u2009=\u20091.74, 95%CI: 1.54\u20131.99), NAR (OR\u2009=\u20091.44, 95%CI: 1.27\u20131.64), and SIRI (OR\u2009=\u20091.29, 95%CI: 1.15\u20131.46). CCR demonstrated the highest observed accuracy (AUC\u2009=\u20090.768, 95%CI: 0.737\u20130.799). Threshold effect analysis revealed a nonlinear association, with an inflection point at 15: no significant association was observed below this threshold (OR\u2009=\u20091.015,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.558), whereas risk significantly increased above it (OR\u2009=\u20091.212,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among 12 inflammatory biomarkers, CCR showed the strongest predictive value for MSAP\/SAP, with a critical threshold of 15. As an easily obtainable marker, CCR may serve as a practical early warning tool to guide clinical management and risk stratification in AP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1764029","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T06:54:11Z","timestamp":1772088851000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The association between inflammatory indices and acute pancreatitis severity: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Huicong","family":"Ma","sequence":"first","affiliation":[{"name":"Institute of Emergency and Critical Care Medicine, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital)","place":["Qingdao, Shandong, 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