Introduction
Acute pancreatitis (AP) is a sudden inflammatory disorder of the pancreas and represents one of the leading gastrointestinal causes of hospitalisation globally.[1] The clinical presentation varies considerably, ranging from mild disease that resolves with conservative treatment to severe forms associated with significant systemic complications. Severe acute pancreatitis may lead to complications such as pancreatic necrosis, respiratory failure, renal impairment, circulatory shock, and multiple organ dysfunction, all of which contribute to increased mortality. Mortality in mild acute pancreatitis is low, usually around 1%, whereas severe disease is associated with substantially higher fatality rates, reported to range between 15% and 35%. In patients with infected pancreatic necrosis, mortality may increase further, reaching up to 40% in some series.
Acute pancreatitis arises from multiple etiological factors, most commonly gallstones and excessive alcohol intake. The clinical course of acute pancreatitis is typically divided into an early phase and a late phase. The initial phase of the disease, generally within the first week, is primarily characterised by systemic inflammatory response and organ dysfunction. Severe acute pancreatitis is defined by persistent organ failure lasting longer than 48 hours. Early identification of disease severity is essential for appropriate management of patients with acute pancreatitis. C-reactive protein (CRP) and lactate dehydrogenase (LDH) are widely available laboratory investigations routinely performed in patients with acute pancreatitis. CRP is an established inflammatory marker associated with disease severity, while LDH reflects cellular injury and tissue hypoxia and has been shown to correlate with adverse clinical outcomes.[2] Elevated levels of these markers may therefore provide early prognostic information and assist in identifying patients at risk of developing severe acute pancreatitis.
This study is undertaken to evaluate the role of CRP and LDH as prognostic markers in acute pancreatitis and to compare their predictive value with established radiological severity indices. Early identification of severe disease using simple biochemical parameters may facilitate prompt clinical decision-making, optimal allocation of critical care resources, and improved patient outcomes.
Material & Methods
This study was designed as an observational analytical study. The study was conducted in the Department of General Surgery at Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab, India. The study was carried out over a period of one and a half years, from July 2024 to December 2025. The study population comprised patients diagnosed with acute pancreatitis who presented to and were admitted to the above-mentioned institution during the study period.
Patients were included if diagnosed with acute pancreatitis based on at least two of the following: characteristic clinical features, elevated serum amylase and/or lipase levels, or imaging findings on ultrasonography or contrast-enhanced computed tomography. Patients were excluded if they had conditions known to independently elevate C-reactive protein (CRP) and lactate dehydrogenase (LDH) (including autoimmune disorders, inflammatory bowel disease, malignancy, pericarditis, or active infections), had received antibiotics or anti-inflammatory drugs prior to admission, or were on immunosuppressive therapy.
After obtaining written informed consent, all eligible patients underwent detailed clinical evaluation, and blood samples were collected at admission for estimation of serum amylase, serum lipase, C-reactive protein (CRP), and lactate dehydrogenase (LDH). Imaging studies, including ultrasonography and/or contrast-enhanced computed tomography severity using the Computed Tomography Severity Index (CTSI). Patients were categorised into mild, moderate, and severe acute pancreatitis based on CTSI scores, and admission CRP and LDH levels were compared across these groups. All clinical, biochemical, and radiological data were systematically recorded in a predesigned proforma.
Data were entered into Microsoft Excel and analysed using IBM SPSS Statistics (Version 23). Descriptive statistics were used to summarise baseline characteristics, and appropriate statistical tests were applied to determine the association between CRP, LDH, and disease severity. Routine investigations, including haemoglobin, total and differential leukocyte counts, blood urea, serum creatinine, serum amylase, and serum lipase, along with imaging studies, were performed as part of standard clinical care.
Results
The present study was undertaken to evaluate the predictive value of C-reactive protein (CRP) and lactate dehydrogenase (LDH) in assessing the severity of acute pancreatitis. A total of 65 patients diagnosed with acute pancreatitis and fulfilling the predefined inclusion criteria were included in the study. All patients were admitted during the study period and were evaluated clinically, biochemically, and radiologically.
As shown in (Table Ⅰ), the majority of participants were aged 26–50 years (69.2%), followed by those aged <25 years (26.2%), while only a small proportion (4.6%) were aged ≥51 years. Males constituted the majority (58.5%) of the study population, whereas females accounted for 41.5%, indicating a slight male predominance. Among the study participants (Table Ⅱ), 16.9% had a history of alcohol consumption, while the majority (83.1%) did not report such a history. Gallstone disease was observed in 7.7% of patients, representing a relatively small subset of the study population.
| Variable | Category | Frequency (n) | Percentage (%) |
| Age (years) | <25 | 17 | 26.2 |
| 26–50 | 45 | 69.2 | |
| ≥51 | 3 | 4.6 | |
| Sex | Male | 38 | 58.5 |
| Female | 27 | 41.5 | |
| Total | 65 | 100 |
| Variable | Category | Frequency (n) | Percentage (%) |
| Alcohol | No | 54 | 83.1 |
| Yes | 11 | 16.9 | |
| Gallstone | No | 60 | 92.3 |
| Yes | 5 | 7.7 | |
| Total | 65 | 100 |
As shown in (Table Ⅲ), elevated total leukocyte count (>11,000 cells/μL) was observed in 56.9% of patients. A large majority of participants had raised inflammatory markers, with 90.8% exhibiting CRP levels >5 mg/dL and an equal proportion (90.8%) demonstrating LDH levels >280 IU/L.
| Parameter | Category | Frequency (n) | Percentage (%) |
| TLC (cells/μL) | 4000–11000 | 28 | 43.1 |
| >11000 | 37 | 56.9 | |
| CRP (mg/dL) | <5 | 6 | 9.2 |
| >5 | 59 | 90.8 | |
| LDH (IU/L) | 140–280 | 6 | 9.2 |
| >280 | 59 | 90.8 | |
| Total | 65 | 100 |
As shown in (Table Ⅳ), both CRP and LDH demonstrated a progressive increase in mean ranks with increasing severity of acute pancreatitis based on the CT Severity Index (CTSI). CRP showed a significant association with severity (χ² = 14.040, df = 2, p = 0.001), while LDH demonstrated a highly significant association (χ² = 27.893, df = 2, p < 0.001). Notably, LDH exhibited a stronger association compared to CRP. Overall, both biomarkers were significantly associated with increasing disease severity.
| Variable | Mild (Mean Rank) | Moderate (Mean Rank) | Severe (Mean Rank) | χ² | df | p-value |
| CRP | 26.04 | 38.39 | 50.22 | 14.040 | 2 | 0.001 |
| LDH | 24.01 | 37.71 | 60.00 | 27.893 | 2 | <0.001 |
Binary logistic regression analysis was performed with severe CTSI as the dependent variable. CRP and LDH were entered as continuous variables. A p-value <0.05 was considered statistically significant. As shown in (Table Ⅴ), both CRP and LDH were significant independent predictors of severe CT Severity Index. CRP demonstrated a statistically significant association (p = 0.010), whereas LDH showed a highly significant association (p < 0.001). The odds of severe disease increased by 0.6% and 0.7% per unit rise in CRP and LDH, respectively. Notably, LDH exhibited a stronger predictive effect, as reflected by its higher Wald statistic and level of significance.
| Variable | B | S.E. | Wald | p-value | Exp(B) | 95% CI for Exp(B) |
| CRP | 0.006 | 0.002 | 6.649 | 0.010 | 1.006 | 1.002–1.011 |
| LDH | 0.007 | 0.002 | 14.067 | <0.001 | 1.007 | 1.003–1.011 |
Discussion
In the present study, the majority of patients belonged to the 26–50 years age group (69.2%), with a mean age of approximately 40 years. This observation is consistent with previously published literature indicating that acute pancreatitis predominantly affects individuals in the third to fifth decades of life. Khanna et al.,[3] reported a similar age distribution, with the highest incidence observed between 31 and 50 years. The comparable age pattern observed in the present study reinforces the established epidemiological trend that acute pancreatitis commonly affects the economically productive age group. Male predominance was observed in the present cohort (58.5%), with females constituting 41.5% of cases. This finding aligns with earlier studies. Al Mofleh et al.,[4] reported a higher incidence among males, largely attributed to alcohol-related pancreatitis.
Elevated CRP levels (>5 mg/dL) were observed in 90.8% of patients. This finding corresponds with observations by Del Prete et al.,[5] who demonstrated that CRP is highly sensitive in detecting necrotising pancreatitis. Similarly, elevated LDH levels (>280 IU/L) were present in 90.8% of cases. Ueda et al.,[6] highlighted the role of LDH in simplified prognostic scoring systems. The high prevalence of elevated CRP and LDH in the present study reflects significant inflammatory and cellular injury responses among admitted patients. According to CT Severity Index (CTSI), 56.9% of patients were categorised as mild, 29.2% as moderate, and 13.8% as severe. This distribution is comparable to findings reported by Al Mofleh et al.,[4] who noted that approximately 15–20% of patients develop severe disease. The predominance of mild cases in the present cohort mirrors trends described in contemporary literature.
Mean serum CRP and LDH levels demonstrated a progressive increase with increasing CT Severity Index categories in the present study. Patients with severe pancreatitis exhibited substantially higher mean biomarker levels compared to those with mild and moderate disease. This finding further supports the association between elevated inflammatory and tissue injury markers and increasing radiological severity of acute pancreatitis. With regard to association analysis, a statistically significant progressive increase in the mean ranks of both CRP and LDH was observed with increasing CT Severity Index (CTSI) categories. Patients with elevated CRP (≥5 mg/dL) and LDH (>280 IU/L) were more frequently observed in the moderate and severe CTSI groups, further supporting the role of these biomarkers in identifying patients at higher risk of severe disease. CRP demonstrated a significant association with CTSI (p = 0.001), which is consistent with findings reported by Khanna et al.,[3] and Cardoso et al.,[7] Binary logistic regression analysis further demonstrated that both CRP and LDH independently predicted severe CTSI. However, LDH exhibited higher explanatory power and overall classification accuracy. Negi et al.,[8] reported significant predictive value of CRP, whereas Zrnić et al.,[9] and Mounzer et al.,[10] emphasised the prognostic utility of LDH. The present findings support the growing evidence that LDH may serve as a strong early predictor of severe acute pancreatitis.
The findings of the present study have important clinical implications. Early identification of patients at risk of severe acute pancreatitis is essential for timely management and prevention of complications. Simple and widely available biochemical markers such as CRP and LDH may serve as useful tools for early risk stratification, particularly in resource-limited settings where complex scoring systems may not be readily available. Measurement of these biomarkers at admission may assist clinicians in identifying patients who require closer monitoring, early imaging, and more aggressive supportive care. The findings demonstrated that both CRP and LDH were significantly associated with increasing CT severity. A progressive rise in biomarker levels was observed with increasing CTSI categories.
This study enabled direct comparison of CRP and LDH using CTSI as an objective reference, with LDH showing superior predictive value. However, the small sample size, single-centre design, and lack of serial biomarker assessment and alternative severity scores limit generalisability.
Recommendations
Serum LDH, owing to its superior predictive performance, may be considered a valuable early marker for identifying severe acute pancreatitis, particularly in resource-limited settings. Routine assessment of both CRP and LDH at admission can facilitate early risk stratification and guide timely clinical decision-making, including intensive monitoring and intervention. Incorporating these readily available biomarkers into initial evaluation protocols may help improve patient outcomes and optimise resource utilisation.
Conclusion
Both markers showed a significant positive association with disease severity and independently predicted severe CTSI. However, LDH demonstrated superior predictive performance, with higher correlation and better diagnostic accuracy than CRP. While CRP showed relatively higher specificity, LDH exhibited greater sensitivity. Overall, LDH appears to be a more robust early predictor, and its combined use with CRP may improve early risk stratification and clinical decision-making in acute pancreatitis.
Declarations
Ethical Clearance
Ethical clearance for the study was obtained from the Institutional Ethics Committee of Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, vide Reference No. SGRD/IEC/2024-304, dated 18 May 2024.
Authors’ Contributions
All authors contributed substantially to the conception, data acquisition, analysis, drafting, and critical revision of the manuscript. All authors have read and approved the final version of the manuscript.
Financial support and sponsorship
Nil.
Conflicts of Interest
There are no conflicts of interest.