{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:47:03Z","timestamp":1790660823671,"version":"4.1.0"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>Objective: Due to the varied clinical manifestations of acute pancreatitis (AP), prompt identification of patients predisposed to extended hospitalization is essential for efficient resource allocation. This study assessed the predictive efficacy of inflammatory and immunonutritional ratios\u2014namely, C-reactive protein\/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and hemoglobin, albumin, lymphocyte, and platelet score (HALP)\u2014in predicting hospitalizations lasting more than 7 days. Methods: A retrospective cohort analysis was performed on 306 patients treated at a tertiary center from June 2020 to June 2025. We used Mann\u2013Whitney U tests, ROC analysis, and multivariate logistic regression models to evaluate the relationship between admission laboratory-derived ratios and length of stay. Results: In total, 27.5% (n = 84) of the cohort experienced prolonged hospitalization. Individual markers exhibited moderate discrimination; however, procalcitonin and CAR displayed high negative predictive values (&gt;85%), demonstrating clinical utility in excluding prolonged hospital stays. Multivariate analysis revealed advanced age (p &lt; 0.001) and increased CAR (p &lt; 0.001) as the most significant independent predictors. On the other hand, the HALP score was much lower in the group that stayed longer, but it was not an independent predictor in the multivariate model. Conclusions: Older age and a higher CAR are both independent factors that can predict longer hospital stays in AP. The high negative predictive value of CAR is important because it represents a reliable way to exclude prolonged hospitalization. Low CAR levels at admission may help clinicians identify patients eligible for early discharge, thereby optimizing bed management.<\/jats:p>","DOI":"10.3390\/metabo16050320","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:17:42Z","timestamp":1778519862000},"page":"320","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predicting Prolonged Length of Stay in Acute Pancreatitis: Comparison of the CRP-to-Albumin Ratio with Other Inflammatory and Immunoutritional Indices"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8561-4455","authenticated-orcid":false,"given":"\u00dcmit","family":"Karatepe","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Elaz\u0131\u011f Fethi Sekin City Hospital, Elaz\u0131\u011f 23300, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6772-8827","authenticated-orcid":false,"given":"Ber\u00e7em","family":"Af\u015far Karatepe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Elaz\u0131\u011f Fethi Sekin City Hospital, Elaz\u0131\u011f 23300, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis\u20142012: Revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1053\/j.gastro.2018.01.032","article-title":"American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis","volume":"154","author":"Crockett","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/S0140-6736(20)31310-6","article-title":"Acute pancreatitis","volume":"396","author":"Boxhoorn","year":"2020","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1053\/j.gastro.2018.12.041","article-title":"Organ failure due to systemic injury in acute pancreatitis","volume":"156","author":"Garg","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1152\/physrev.00003.2021","article-title":"The roles of calcium and ATP in the physiology and pathology of the exocrine pancreas","volume":"101","author":"Petersen","year":"2021","journal-title":"Physiol. Rev."},{"key":"ref_6","first-page":"e39515","article-title":"Comparing prognostic scores and inflammatory markers in predicting the severity and mortality of acute pancreatitis","volume":"15","author":"Jain","year":"2023","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1053\/j.gastro.2012.03.005","article-title":"Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis","volume":"142","author":"Mounzer","year":"2012","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1038\/ajg.2009.622","article-title":"Comparison of BISAP, Ranson\u2019s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis","volume":"105","author":"Papachristou","year":"2010","journal-title":"Am. J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.sopen.2024.03.012","article-title":"Predicting the severity of acute pancreatitis: Current approaches and future directions","volume":"19","author":"Metri","year":"2024","journal-title":"Surg. Open Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e013206","DOI":"10.1136\/bmjopen-2016-013206","article-title":"Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: A retrospective cohort study","volume":"7","author":"Li","year":"2017","journal-title":"BMJ Open"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zhou, H., Mei, X., He, X., Lan, T., and Guo, S. (2019). Severity Stratification and Prognostic Prediction of Patients with Acute Pancreatitis at Early Phase: A Retrospective Study. Medicine, 98.","DOI":"10.1097\/MD.0000000000015275"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/S1499-3872(17)60007-9","article-title":"Predictive value of C-reactive protein\/albumin ratio in acute pancreatitis","volume":"16","author":"Kaplan","year":"2017","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1007\/s11605-012-2121-1","article-title":"The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in acute pancreatitis: Identification of an optimal NLR cutoff","volume":"17","author":"Suppiah","year":"2013","journal-title":"J. Gastrointest. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.2147\/OTT.S154162","article-title":"Prognostic value of platelet-to-lymphocyte ratio in pancreatic cancer: A comprehensive meta-analysis of 17 cohort studies","volume":"11","author":"Zhou","year":"2018","journal-title":"Onco Targets Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1159\/000529366","article-title":"Early predictors of infected pancreatic necrosis in severe acute pancreatitis: Implications of neutrophil-to-lymphocyte ratio, blood procalcitonin concentration, and modified CT severity index","volume":"41","author":"Zhu","year":"2023","journal-title":"Dig. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.surg.2009.02.013","article-title":"The value of procalcitonin at predicting the severity of acute pancreatitis and development of infected pancreatic necrosis: Systematic review","volume":"146","author":"Mofidi","year":"2009","journal-title":"Surgery"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/s00063-021-00855-8","article-title":"Predictors of prolonged hospitalization in patients with mild and moderate pancreatitis presenting to the emergency department","volume":"117","author":"Pekdemir","year":"2022","journal-title":"Med. Klin. Intensivmed. Notfmed."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.pan.2023.11.008","article-title":"Factors predictive of hospital length of stay in patients with an index episode of acute necrotizing pancreatitis","volume":"24","author":"Obaitan","year":"2024","journal-title":"Pancreatology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1111\/cts.13445","article-title":"Relationship between blood glucose levels and length of hospital stay in patients with acute pancreatitis: An analysis of MIMIC-III database","volume":"16","author":"Wang","year":"2023","journal-title":"Clin. Transl. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"72","DOI":"10.4274\/MMJ.galenos.2025.73848","article-title":"The role of combined C-reactive protein and albumin indices in predicting prolonged hospital stay in acute pancreatitis: A prospective observational study","volume":"40","author":"Algin","year":"2025","journal-title":"Medeni Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.gtc.2024.09.001","article-title":"Organ Failure and Prediction of Severity in Acute Pancreatitis","volume":"54","author":"Mahapatra","year":"2025","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"118","DOI":"10.21614\/sgo-26-2-296","article-title":"A Closer Look: Assessment of Acute Pancreatitis Prognosis Using Neutrophil-Lymphocyte Ratio","volume":"26","author":"Fonseca","year":"2021","journal-title":"Surg. Gastroenterol. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1159\/000331494","article-title":"Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis","volume":"11","author":"Azab","year":"2011","journal-title":"Pancreatology"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ibrahim, M.Y., Alhaj, M.M., Ibrahim, A.A.A., Rabih, M., Rabih, M.R.M., Massaad, M.E.H., Elzubir, A.K., Abdelrahman, M.M.H., Abdelrahman, O.A.E., and Mohamed, S.O.O. (2025). Association of platelet-lymphocyte ratio with acute pancreatitis severity: Systematic review and meta-analysis. BMC Gastroenterol., 26.","DOI":"10.1186\/s12876-025-04556-w"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e7487","DOI":"10.1097\/MD.0000000000007487","article-title":"Early prediction of infected pancreatic necrosis secondary to necrotizing pancreatitis","volume":"96","author":"Chen","year":"2017","journal-title":"Medicine"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Tarj\u00e1n, D., Szalai, E., Lipp, M., Verb\u00f3i, M., K\u00f3i, T., Er\u0151ss, B., Teutsch, B., Faluhelyi, N., Hegyi, P., and Mik\u00f3, A. (2024). Persistently high procalcitonin and C-reactive protein are good predictors of infection in acute necrotizing pancreatitis: A systematic review and meta-analysis. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25021273"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"722","DOI":"10.5152\/tjg.2022.22098","article-title":"The diagnostic value of procalcitonin in patients with severe acute pancreatitis: A meta-analysis","volume":"33","author":"Chen","year":"2022","journal-title":"Turk. J. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"109496","DOI":"10.1016\/j.intimp.2022.109496","article-title":"Hemoglobin, albumin, lymphocyte, and platelet (HALP) score and cancer prognosis: A systematic review and meta-analysis of 13,110 patients","volume":"114","author":"Xu","year":"2023","journal-title":"Int. Immunopharmacol."},{"key":"ref_29","first-page":"33","article-title":"The role of hemoglobin, albumin, lymphocyte, platelet (HALP) score in acute pancreatitis: An analytical study","volume":"14","author":"Duman","year":"2024","journal-title":"Value Health Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"153","DOI":"10.18632\/oncotarget.28367","article-title":"What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP\u2019s prognostic ability in different cancer types","volume":"14","author":"Farag","year":"2023","journal-title":"Oncotarget"}],"container-title":["Metabolites"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-1989\/16\/5\/320\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:44:56Z","timestamp":1778521496000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-1989\/16\/5\/320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["metabo16050320"],"URL":"https:\/\/doi.org\/10.3390\/metabo16050320","relation":{},"ISSN":["2218-1989"],"issn-type":[{"value":"2218-1989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]}}}