Comparison of Different Scoring Systems in Predicting the Severity of Acute Pancreatitis: A Prospective Observational Study

Abstract

Background Acute pancreatitis (AP) is an inflammatory condition of the pancreas mostly due to alcohol or gallstones. Various scoring systems were involved in identifying the severity of the disease. The standard single score to identifying the severity remains uncertain. Methodology This prospective observational study was carried out for two years in a tertiary care center from South India. The diagnosis of AP was made based on Atlanta criteria, and a total of 164 patients were included. All patients were assessed by acute physiology and chronic health evaluation ll (APACHE II), bedside index for severity in AP (BISAP), modified Glasgow score (MGS), and Ranson score on admission and 48 hours after admission scores. Procalcitonin was done in all patients with AP. Contrast-enhanced computed tomography (CT) of the abdomen was done in 69 patients who had features of severe acute pancreatitis (SAP). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for each score, and procalcitonin for CT documented severe patients and organ failure patients together. Results A total of 164 patients were included in this study. CT abdomen showed a modified CT severity index (MCSI) ≥8 in all 69 (100%) patients. APACHE II score could predict SAP based on CT findings in 44 patients (63.76%), BISAP score in 22 patients (31.88%), MGS in 55 patients (79.71%), Ranson score at admission in 31 patients (44.92%), Ranson score 48 hours after admission in 44 patients (63.76%), and procalcitonin on admission in 69 patients (100%) when cutoff used as per the literature. APACHE II score could predict SAP in cases of AP (n=164) in 52 patients (50%), BISAP score in 27 patients (26%), MGS in 79 patients (76%), Ranson score at admission in 34 patients (33%), and Ranson score 48 hours after admission in 61 (59%) patients when cutoff was used as per the literature. This study demonstrated that Ranson score on admission had a good area under the curve (AUC). AUC (0.8483), APACHE II (AUC 0.7708), and Ranson score 48 hours after admission (AUC 0.8167) had a fair accuracy. BISAP (AUC 0.6399) and MGS (AUC 0.6486) had poor accuracy for the prediction of severity in AP based on receiver operator characteristic (ROC) curves.

Evaluation of four scoring systems in prognostication of acute pancreatitis for elderly patients

“…These changes can increase the specificity while slightly reducing the sensitivity of the four scoring systems. CTSI and MTSI are good predictors of both mortality and AP severity [27,40]. Although their calculation require radiological expertise, they provide more precise information if they are combined with the four aforementioned scoring systems in the future.…”

Electrocardiogram Heart Rate as a Predictor of Severity in Acute Alcohol-Related Pancreatitis With Alcohol Withdrawal Syndrome

“…APACHE and BISAP scores were not calculated in any of these studies, nor was AWS a complication reported in either study. In a study by Venkatesh et al, a comparison of scoring systems in 164 patients (115 with AAP) was studied, but without the component of alcohol withdrawal [ 16 ]. Only 23% (40/168) of patients in a study from Delhi was due to AAP [ 17 ].…”

COVID-19-associated pancreatic dysfunction

“…Among them, Ranson's score diagnostic accuracy on admission is higher for prediction of severity, organ failure, and mortality based on receiver operator characteristic curves. 25,26 These scoring systems may be used for predicting the severity and mortality of acute pancreatitis in patients with COVID-19.…”