Comparative Predictive Value of the Harmless Acute Pancreatitis Score, Ranson Score, and Neutrophil-to-Lymphocyte Ratio for Mortality Prediction in Patients with Acute Pancreatitis Presenting to the Emergency Department

Objective: Early risk stratification in acute pancreatitis (AP) is essential for guiding clinical decisions in the emergency department (ED). This study aimed to compare the clinical utility of three accessible indicators—Harmless acute pancreatitis score (HAPS), Ranson score, and neutrophil-to-lymphocyte ratio (NLR)—in predicting in-hospital mortality.
Material and Methods: This retrospective cohort study included 347 adult patients (≥18 years) diagnosed with non-traumatic AP between January 2020 and January 2024 at a tertiary care ED. The diagnosis was established using the American College of Gastroenterology criteria. HAPS, Ranson score (based on admission data), and NLR were calculated at initial presentation. Patients with chronic pancreatitis, traumatic etiology, malignancy-related AP, or incomplete data were excluded. Predictive performance for in-hospital mortality was evaluated using receiver operating characteristic analysis and compared using the DeLong test.
Results: In-hospital mortality occurred in 35 patients (10.1%). HAPS showed a sensitivity of 82.9%, specificity of 64.7%, and a negative predictive value (NPV) of 97.1%. Ranson score had a sensitivity of 68.6%, specificity of 72.8%, and NPV of 95.4%. NLR ≥4.9 yielded a sensitivity of 82.9%, specificity of 59.9%, and NPV of 96.9%. Area under the curve (AUC) values were 0.757 [95% confidence interval (CI): 0.708-0.801] for HAPS, 0.755 (95% CI: 0.706-0.799) for Ranson, and 0.642 (95% CI: 0.589-0.692) for NLR. No significant difference was observed between HAPS and Ranson (p=0.956), while comparisons involving NLR approached statistical significance.
Conclusion: HAPS and Ranson scores demonstrated comparable and superior performance in predicting in-hospital mortality in patients with AP. Due to its simplicity and excellent NPV, HAPS may be particularly useful as a bedside exclusion tool in the emergency setting.

Keywords: Acute pancreatitis, mortality prediction, emergency department, risk stratification, Harmless acute pancreatitis score