Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2387-2394
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2387
Comparison of scoring systems in predicting the severity of acute pancreatitis
Joon Hyun Cho, Tae Nyeun Kim, Hyun Hee Chung, Kook Hyun Kim
Joon Hyun Cho, Tae Nyeun Kim, Hyun Hee Chung, Kook Hyun Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea
Author contributions: Kim TN and Cho JH designed the research; Cho JH and Chung HH performed the research; Cho JH and Chung HH analyzed the data; Cho JH, Kim TN, Chung HH and Kim KH wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tae Nyeun Kim, MD, PhD, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 317-1, Daemyung 5-dong, Nam-gu, Daegu 705-717, South Korea. tnkim@yu.ac.kr
Telephone: +82-53-6203842 Fax: +82-53-6548386
Received: August 6, 2014
Peer-review started: August 8, 2014
First decision: October 14, 2014
Revised: October 28, 2014
Accepted: December 1, 2014
Article in press: December 1, 2014
Published online: February 28, 2015
Abstract

AIM: To investigate the prognostic usefulness of several existing scoring systems in predicting the severity of acute pancreatitis (AP).

METHODS: We retrospectively analyzed the prospectively collected clinical database from consecutive patients with AP in our institution between January 2011 and December 2012. Ranson, Acute Physiology and Chronic Health Evaluation (APACHE)-II, and bedside index for severity in acute pancreatitis (BISAP) scores, and computed tomography severity index (CTSI) of all patients were calculated. Serum C-reactive protein (CRP) levels were measured at admission (CRPi) and after 24 h (CRP24). Severe AP was defined as persistent organ failure for more than 48 h. The predictive accuracy of each scoring system was measured by the area under the receiver-operating curve (AUC).

RESULTS: Of 161 patients, 21 (13%) were classified as severe AP, and 3 (1.9%) died. Statistically significant cutoff values for prediction of severe AP were Ranson ≥ 3, BISAP ≥ 2, APACHE-II ≥ 8, CTSI ≥ 3, and CRP24≥ 21.4. AUCs for Ranson, BISAP, APACHE-II, CTSI, and CRP24 in predicting severe AP were 0.69 (95%CI: 0.62-0.76), 0.74 (95%CI: 0.66-0.80), 0.78 (95%CI: 0.70-0.84), 0.69 (95%CI: 0.61-0.76), and 0.68 (95%CI: 0.57-0.78), respectively. APACHE-II demonstrated the highest accuracy for prediction of severe AP, however, no statistically significant pairwise differences were observed between APACHE-II and the other scoring systems, including CRP24.

CONCLUSION: Various scoring systems showed similar predictive accuracy for severity of AP. Unique models are needed in order to achieve further improvement of prognostic accuracy.

Keywords: Severity, Scoring systems, Predictors, Acute pancreatitis, Severe acute pancreatitis

Core tip: Only a few studies have evaluated the comparison of various scoring systems including bedside index for severity in acute pancreatitis in predicting the severity of acute pancreatitis (AP) according to the revised Atlanta Classification. Based on our study, Acute Physiology and Chronic Health Evaluation (APACHE)-II score appeared to have highest accuracy for prediction of severe AP, although the predictive accuracy of APACHE-II was not significantly different compared to that of the other scoring systems, including C-reactive protein. Various scoring systems most widely used for early prediction of severity of AP showed similar predictive accuracy for severity of AP, and unique models are needed in order to achieve further improvement of predictive accuracy.