Aim The aim of this study was to evaluate the efficacy of CRP/Albumin ratio in predicting the need for surgical treatment and mortality in preterms whose gestational age <32 weeks with NEC.

Material and Method In our study, infants between 1–28 days of gestation with a gestational age <32 weeks who were admitted to the neonatal clinic between January 1, 2015 and October 1, 2022 and diagnosed with NEC were included. General patients demographics, epidemiologics, clinical and laboratory parameters were recorded. Receiver operating characteristic (ROC) curve analysis was used to evaluate the optimal predictive values of CAR.

Results Of the 81 patients, 54% had a birth weight of ≤1000 g and 49% were born at ≤28 weeks of gestation. Twent-one (26%) patients were operated for NEC and the mortality rate was 31%. CRP/ALB ratio of ≥0,73 on day 2 [AUC 0,67 (95% CI 0,54–0,81); p=0,009] and ≥1,66 on day 3 [(AUC 0,66 (95% CI (0,53–0,79); p = 0,014] of NEC diagnosis found to be statistically significant in predicting for surgery. CRP/ALB ratio of ≥2,88 on day 1 [(AUC 0,69 (95% CI 0,57–0,82); p=0,002], CRP/ALB ratio of ≥3,15 on day 2 [(AUC 0,78 (95% CI 0,67–0,89); p<0,001], and CRP/ALB ratio of ≥1,72 on day 3 [(AUC 0,76 (95% CI 0,65–0,88); p=0,001] was found a significantly good predictive value for mortality. We showed that patients with NEC stage 2–3 were 23 times more likely to undergo surgery than patients with NEC stage 1 and hyponatremia, gestational week and length of hospital stay also affected mortality.

Conclusions C-reactive protein/albumin ratio is an useful and easily measured parameter with a good sensitivity in predicting the need for surgical treatment and mortality in necrotizing enterocolitis.