Diagnostic Performance of the Uric Acid-To-Albumin Ratio in Predicting Severity of Acute Pancreatitis.

AIM: The uric acid-to-albumin ratio (UAR) has shown prognostic value in several inflammatory conditions, but its role in acute pancreatitis (AP) remains unclear. This study evaluated the prognostic value of UAR for disease severity in patients with AP. METHODS: In this single-center, retrospective study, 147 patients hospitalized with acute pancreatitis between February 2025 and June 2026 were included. UAR, systemic immune-inflammation index (SII), and platelet-to-lymphocyte ratio (PLR) were calculated. Disease severity was classified using the revised Atlanta classification and the BISAP score. Diagnostic performance was assessed by receiver operating characteristic (ROC) analysis with pairwise area under the curve (AUC) comparisons (DeLong method). RESULTS: Thirty-eight patients (25.9%) had moderate-to-severe AP. UAR was higher in the moderate-to-severe group than in the mild group (1.65 ± 0.47 vs. 1.27 ± 0.34; p < 0.001) and increased across BISAP score categories (p < 0.001). UAR had an AUC of 0.741 (95% CI: 0.662-0.810), compared with 0.706 for SII and 0.646 for PLR; however, pairwise differences were not statistically significant. At a cut-off of > 1.54 (Youden index), UAR had a specificity of 82.57% and a negative predictive value of 84.90%. Combining UAR with age increased the AUC to 0.801 and the negative predictive value to 88.57%. Bootstrap validation yielded an optimism-corrected AUC of 0.794. UAR was associated with moderate-to-severe AP in univariable analysis (OR: 10.517; 95% CI: 3.770-29.336; p < 0.001), but not after multivariable adjustment (adjusted OR: 3.462; 95% CI: 0.870-13.773; p = 0.078). CONCLUSIONS: UAR is a simple, inexpensive biomarker with potential utility in acute pancreatitis severity assessment. Although not independently predictive, it may provide complementary information alongside clinical and laboratory findings.