Acute pancreatitis (AP) is a frequently occurring presenting condition. The reported yearly incidence ranges between 13 and 45 per 100,000 individuals.1   The updated Atlanta categorization system divides AP into three categories: mild, moderately severe, and severe AP. This categorization is based on whether or not there are any local or systemic problems. Acute pancreatitis without any local or systemic consequences is known as MAP. Moderately severe refers to individuals with AP who develop any of the following local complications: acute accumulation o liquids, acute necrotic accumulation, pseudocyst development, and/or walled-off necrosis; or who have transitory organ failure for less than 48 hours .2 The primary concern in the therapy of individuals with AP is the development of moderately severe AP to severer forms, which are linked with substantial morbidity and death 3,4. Both moderately severe and severe AP are frequently classed together as complicated acute pancreatitis (CAP), and this classification has its own practical usefulness.5,6 The reported death rate of 30%-40% for individuals with complicated acute pancreatitis is cause for great worry .7 As a result, it is not surprising that there has always been interest in developing and/or validating multifactorial scoring systems or single predictors that can identify patients at a higher risk of progressing to CAP.8 CRP is one among these predictors .

 It is an acute-phase proteins substance that is secreted by the liver when responding to any inflammatory situation in the body.9 Since then, there have been contradictory findings on its usefulness as a predictor of CAP. Furthermore, there is ambiguity concerning the appropriate timing to assess CRP and its optimal cut-off values.8 Cardoso et al., for example, observed that its greatest usage occurred after 48 hours with a cut-off value of 180-190 .10 others have proposed a cut-off value of 150 at 48 hours to predict the severity of acute pancreatitis .11 To compound the matter, recently the idea of interval variation in a CRP of over 90 was presented as a stronger predictor.12 This study was conducted to find out the diagnostic Accuracy of C - reactive protein in predicting mortality among patients with acute pancreatitis.

The present observational cross-sectional study was carried out at the General Surgery Department Bolan Medical College Quetta from July 2025 to December 2025 after the approval of the ethical committee of the hospital. The Buderer equation for both specificity and sensitivity research was used to determine the frequency of participants needed for the study project. Based on prior research, we estimated a 95% confidence interval with 81.48% sensitivity, 91.04% specificity, 9% needed accuracy, and a 22% death rate.13 Participants of both genders aged 22-62 years with a typical clinical history & physical signs of acute pancreatitis were enrolled while individuals with acute pancreatitis caused by trauma, surgery, or ERCP treatment were excluded. The non-probability sequential sampling approach was used. Each participant was admitted to ICU .The CRP levels were assessed 48 hours after admission. All patients were treated based on the most recent recommendations for acute pancreatitis.14 If Participants were discharged before the 28th day of hospitalization, they were followed up in the OPD to document the ultimate outcome. Specially prepared forms were used to collect patient details, including demographics & lab results. Data were analyzed using SPPS version 20. Data such as age and CRP were expressed as mean and Standard deviation. Categorical variables were expressed in percentages and frequencies using a 2 x 2 contingency table and a CRP level of > 121 mg/dl as the benchmark of excellence, numerous parameters were used to assess survival or fatalities on the 28th post-admission day. This covered diagnostic accuracy, specificity, sensitivity, PPV and NPV. The results were stratified by gender, age, and length of hospital stay. Statistical significance was determined using a post-stratification Chi-square or Fisher exact test. A p-value of less than 0.05 was regarded as statistically significant.

A total of 170 individuals participated in this study out of which male were 54(25.8%) and female were 116(68.2%). The mean age of the study population was 41.22±11.08 years (ranged 22-62 years). the mean hospital stay was 6.04±2.18 days (4-25 days).Out of the total participants 90(52.9%) had hospital stay were 5days. The total death rate among the study participant was 26(15.2%). the mean CRP level of the study participants was 151.00±68.88 mg/dl.  In 70 individuals (41.17%), the level of CRP was less than 121 mg/dL. With a CRP level more than 121 mg/dl as the reference, the diagnostic accuracy of the CRP level to detect mortality within 28 days was 57.7%.The results showed that the sensitivity was(92.3%) specificity(52.8%) , diagnostic accuracy(57.7%), NPV(97.1%) and PPV was ( 24% and as presented in table2. 

Pancreatitis is a prevalent illness with extensive clinical variations, and its prevalence is growing. Acute pancreatitis can range in intensity from mild, self-limiting inflammation to pancreatic necrosis with life-threatening complications. The severity of acute pancreatitis is associated with systemic organ dysfunction and/or necrotizing pancreatitis. Proper observation & risk stratification are crucial for identifying high-risk patients with acute pancreatitis and reducing morbidity and death rates.15 The present study evaluated the accuracy of CRP in predicting death in acute pancreatitis. High levels of serum CRP at 48 hours after admission can be was used as an inflammatory indicator to classify the risk of fatality in individuals with a severe illness. A total of 170 individuals participated in this study out of which male were 54(25.8%) and female were 116(68.2%). The mean age of the study population was 41.22±11.08 years (ranged 22-62 years). The mean hospital stay was 6.04±2.18 days (4-25 days).Similar demographic features were reported from the study conducted by Haider.16 In their study female were the predominant gender and the age rage was from 20-62 years which support our study. The total death rate among the study participant was 26(15.2%).Our study findings are similar to the previous study in which mortality was 15%.16 But the results of the current study were not similar to the study of Vengadakrishnan et al in their study a total of 110 patients were examined of out of which fifty patients needed intensive care, and 9 patients (18%) of them died. so the mortality was slightly high in their research.15 Acute pancreatitis mortality is strongly related to illness severity, and it can be as high as thirty percent in severe cases.16 This study assessed the sensitivity, specificity, predictive values, and diagnostic accuracy of CRP levels in detecting 28-day mortality using CRP levels >121 as the gold standard. The study found that the sensitivity was 92.3% specificity was 52.8. These findings are comparable to the previous study.16 A CRP level above 121 mg/dl has been demonstrated to be a fairly reliable indicator. To differentiate between moderate and severe acute pancreatitis, CRP levels should be evaluated 48 hours after admission.18 CRP testing is cost-effective and widely accessible, making it excellent for resource-limited settings. Our investigation found that estimating CRP alone does not reliably predict death. Raised CRP levels had high sensitivity but moderate specificity in predicting 28-day death. This may be due to a small sample size or the inclusion of both mild & severe pancreatitis patients. A larger sample size and appropriate illness severity categorization using grading systems like BISAP, Ranson, APACHE, etc. can lead to better outcomes. Combining CRP calculation with other biomarkers and grading systems may improve illness prediction and accuracy. The timing of illness start and initial emergency department visit is a significant complicating factor. Delayed presentation might lead to higher CRP levels.

Our study concluded that assessing serum CRP levels 48 hours after admission can help predict mortality risk. It may also offer guidance for a long stay in the hospital.