Sequential organ failure assessment score is superior to other prognostic indices in acute pancreatitis

Table 1 Demographic and clinical profile of patients with acute pancreatitis n (%)

Characteristic	Overall study population (n = 653)	Mild to moderately severe AP (n = 572)	Severe AP (n = 81)	P value
Mean age at admission (Range)	58.7 ± 17.5 (20-98)	57.9 ± 17.0 (20-95)	64.2 ± 20.0 (20-98)	0.002a
Gender
Male	383 (58.7)	334 (58.4)	49 (60.5)	0.285
Ethnicity				0.099
Chinese	458 (70.1)	391 (68.4)	67 (82.7)
Malay	43 (6.6)	36 (6.3)	7 (8.6)
Indian	108 (16.5)	102 (17.8)	6 (7.4)
Others	44 (6.7)	43 (7.5)	1 (1.2)
Comorbidities
Hypertension	339 (51.9)	283 (49.5)	56 (69.1)	0.005a
T2DM	204 (31.2)	168 (29.4)	36 (44.4)	0.025a
Hyperlipidemia	235 (36)	198 (34.6)	37 (45.7)	0.373
Ischaemic heart disease	81 (12.4)	63 (11.0)	18 (22.2)	0.012a
Cerebrovascular disease	51 (7.8)	43 (7.5)	8 (9.9)	0.768
Renal impairment	42 (6.4)	33 (5.8)	9 (11.1)	0.195
COPD	13 (2.0)	9 (1.6)	4 (4.9)	0.217
Asthma	37 (5.7)	33 (5.8)	4 (4.9)	0.038a
Others	120 (18.4)	107 (18.7)	13 (16.0)	0.919
Medications
Immunosuppressed	2 (0.3)	2 (0.3)	0	0.467
Steroids	9 (1.4)	6 (1.0)	3 (3.7)	0.214
Anticoagulants	32 (4.9)	24 (4.2)	8 (9.9)	0.065
History of smoking	125 (19.1)	118 (20.5)	7 (8.6)	0.042a
History of alcohol consumption	159 (24.4)	145 (25.4)	14 (17.3)	0.454
Previous pancreatic disease	76 (11.6)	67 (11.7)	9 (11.1)	0.112
Chronic pancreatitis	30 (4.6)	29 (5.1)	1 (1.2)	0.098
Previous Cholecystectomy	44 (6.7)	38 (6.6)	6 (7.4)	0.809
Etiology
Gallstones	404 (61.9)	350 (61.2)	54 (66.7)	0.390
Alcohol	38 (5.8)	34 (5.9)	4 (4.9)	0.437
Idiopathic	61 (9.3)	52 (9.1)	9 (11.1)	0.634
Hypertriglyceridemia	19 (2.9)	14 (2.4)	5 (6.2)	0.161
Autoimmune	4 (0.6)	4 (0.7)	0	0.491
Hypercalcemia	3 (0.5)	2 (0.3)	1 (1.2)	0.235
Drug induced	6 (0.9)	3 (0.5)	3 (3.7)	0.065
Others	47(7.2)	44 (7.7)	3 (3.7)	0.343

^aP < 0.05. T2DM: Type 2 diabetes mellitus; COPD: Chronic obstructive pulmonary disease; AP: Acute pancreatitis; Idiopathic: Acute pancreatitis with no etiology despite extensive work up; Others: Etiologies of acute pancreatitis include trauma, pancreas cystic neoplasms, malignancy, iatrogenic causes such as endoscopic retrograde cholangiopancreatography.

Table 2 Evaluation of prognostic indices for severe acute pancreatitis (n = 81), intensive care unit admission (n = 20), and mortality in acute pancreatitis (n = 12)

Score	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	LR+	LR-	Diagnostic odds ratio	Accuracy
SAP
HAPS ≥ 1	79.0	49.7	18.2	94.4	1.569	0.423	3.712	53.3
BISAP ≥ 3	24.7	95.3	42.6	89.9	5.231	0.790	6.618	86.5
APACHE II ≥ 8	80.2	63.3	23.6	95.8	2.186	0.312	7.003	65.4
Ranson’s ≥ 3	92.6	51.9	21.4	98.0	1.926	0.143	13.5	57.0
Glasgow ≥ 3	76.5	68.5	25.6	95.4	2.432	0.342	7.106	69.5
SOFA ≥ 7	13.6	99.7	84.6	89.1	38.84	0.867	44.786	89.0
ICU admission
HAPS ≥ 1	90.0	47.2	5.1	99.3	1.706	0.212	8.057	29.9
BISAP ≥ 3	25.0	93.4	10.6	97.5	3.768	0.803	4.690	91.3
APACHE II ≥ 8	100.0	59.6	6.6	100.0	2.473	0	Nil	60.5
Ranson ≥ 3	100.0	47.9	5.7	100.0	1.918	0	Nil	49.5
Glasgow ≥ 3	75.0	64.5	7.0	99.3	2.110	0.388	5.440	65.1
SOFA ≥ 7	40.0	99.2	61.5	98.1	50.64	0.605	83.733	97.4
Mortality in AP
HAPS ≥ 1	83.3	46.6	2.8	99.3	1.562	0.357	4.371	29.9
BISAP ≥ 3	25	93.1	6.4	98.5	3.642	0.805	4.523	91.9
APACHE II ≥ 8	100	58.7	3.6	100	2.419	0	Nil	59.1
Ranson’s ≥ 3	100	47.3	3.4	100	1.896	0	Nil	48.2
Glasgow ≥ 3	75	63.8	4.1	99.5	2.072	0.392	5.289	64.2
SOFA ≥ 7	50.0	98.9	46.2	99.1	45.786	0.506	90.571	98.0

HAPS: Harmless acute pancreatitis score; BISAP: Bedside index of severity in acute pancreatitis; APACHE II: Acute physiology and chronic health evaluation–II; PPV: Positive predictive value; NPV: Negative predictive value; SAP: Severe acute pancreatitis; ICU: Intensive care unit; AP: Acute pancreatitis. HAPS, BISAP, and APACHE II were calculated at admission, Ranson's and Glasgow's were calculated at 48 h post-admission.