Maximizing the Use of Scoring Systems in the Prediction of Outcomes in Acute Pancreatitis

Abstract

Background/Aims: No single classification system has so far effectively predicted the severity for Acute Pancreatitis (AP). This study compares the effectiveness of classification systems: Original Atlanta (OAC), Revised Atlanta (RAC), Determinant based classification (DBC), PANC 3, Harmless AP Score (HAPS), Japanese Severity Score (JSS), Symptoms Nutrition Necrosis Antibiotics and Pain (SNNAP), and Beside Index of Severity for AP (BISAP) in predicting outcomes in AP. Methods: Scores for BISAP, Panc 3, HAPS, SNNAP, OAC, RAC, and DBC were calculated for 221 adult patients hospitalized for AP. Receiver Operating Characteristic curve analysis and Akaike Information Criteria were used to compare the effectiveness of predicting need for surgery, intensive care unit (ICU) admission, readmission within 30 days, and length of hospital stay. Results: Both the RAC and the DBC strongly predict the length of hospital stay (p < 0.0001 for both) and ICU admission (p < 0.0001 for both). Additionally, both BISAP and PANC 3 showed weak predictive capacity at identifying length of stay and ICU admission. Conclusions: We suggest that BISAP and PANC3 be obtained within the initial 24 h of hospitalization to offer an early prediction of length of stay and ICU admission. Subsequently, RAC and DBC can offer further information later in the course of the disease.

Review of Current Evidence in Acute Pancreatitis

“…e) PANC 3 Score: This is extremely useful due to its efficiency, convenience in usage, and the speed of generating results. It evaluates three variables: Hematocrit > 44 g/dL, BMI > 30 kg/m 2 , and pleural effusion x-ray (the last variable being the most useful one for predicting severe AP) [61].…”

“…A value > 2 signifies a 10-times increased risk of mortality. g) HAPS: It identifies the patients who do not require intensive care and those who would probably not develop severe AP, in 24 h [61]. h) POP: It has greater sensitivity compared to APACHE II and Glasgow.…”

“…It evaluates six variables: age, mean arterial pressure, arterial pH, urea, calcium, and PaO 2 /FiO 2 . The scores range from 0 to 40, a higher score representing higher mortality [51,61,63].…”

“…In the first 24 h, it includes clinical suspicion, an increase in BMI, pleural effusion, and increased APACHE II value as factors. After 24 h, it includes persistent organ failure and/or Glasgow Imrie value > 3, and a higher severity score in case of a CRP value >150 mg/L or increased levels of biomarkers IL-1, IL-6, IL-8, IL-10, procalcitonin, and beta-receptor antagonist [45,46,56,61,66]. l) EPIC: It evaluates the presence of ascites, pleural effusion, and retroperitoneal edema, and predicts the occurrence of early organ failure with a precision similar to or greater than that of SIRS, BISAP, and Balthazar.…”

“…The APACHE II score is extremely effective in the accurate prediction of severity and prognosis of AP, and together with the CT Severity Index, provides outcomes that are superior to the numerous other methods available, this is so because it also evaluates extension and necrosis. Therefore, it may be concluded that Ranson's Criteria does have an advantage when approaching the patient in the emergency room or at the time of admission; however, the APACHE II Score forms the basis for a constant clinical-laboratory combined monitoring [56,57,59,61].…”