Published online Nov 9, 2021. doi: 10.5492/wjccm.v10.i6.355
Peer-review started: April 13, 2021
First decision: July 27, 2021
Revised: August 10, 2021
Accepted: October 11, 2021
Article in press: October 11, 2021
Published online: November 9, 2021
Acute pancreatitis (AP) is a common surgical disease, and severe AP (SAP) can be fatal. Many prognostic indicators, including; acute physiology and chronic health evaluation II (APACHE II), bedside index of severity in acute pancreatitis (BISAP), Glasgow score, harmless acute pancreatitis score (HAPS), Ranson score, and sequential organ failure assessment (SOFA) assesses the severity of AP and predicts mortality.
An accurate scoring system on admission of AP is critical to guide patient disposition and aggressiveness of treatment, resulting in both better patient care as well as better distribution of resources for each institution. Few studies have compared the efficacy of these newer scores in predicting disease severity against classic scores such as Ranson's score and Glasgow score, and fewer still have reported their utility in predicting key clinical outcomes such as intensive care unit (ICU) admission and mortality in AP.
A major concern for clinicians is the gross heterogeneity in clinical presentation and identifying patients predicted to manifest SAP. We evaluated these indices' utility in predicting severity, ICU admission, and mortality.
This is a retrospective cohort study. All patients were scored using Ranson and Glasgow scores within the first 48 h after admission. The APACHE II score, BISAP, HAPS, and SOFA values within 24 h of admission are retrospectively obtained based on laboratory results and patient evaluations recorded on a secure online electronic platform of the hospital. Data with missing data < 10% are extrapolated by means of replacement. Other patient information, such as demographics, disease causes, and patient results are also derived from electronic medical records.
The mean age was 58.7 ± 17.5 years, with 58.7% males. Gallstones (n = 404, 61.9%), alcohol (n = 38, 5.8%), and hypertriglyceridemia (n = 19, 2.9%) were more common aetiologies. 81 (12.4%) patients developed SAP, 20 (3.1%) required ICU admission, and 12 (1.8%) deaths were attributed to SAP. Ranson’s score and APACHE-II demonstrated the highest sensitivity in predicting SAP (92.6%, 80.2% respectively), ICU admission (100%), and mortality (100%). While SOFA and BISAP demonstrated lowest sensitivity in predicting SAP (13.6%, 24.7% respectively), ICU admission (40.0%, 25.0% respectively) and mortality (50.0%, 25.5% respectively). However, SOFA demonstrated the highest specificity in predicting SAP (99.7%), ICU admission (99.2%), and mortality (98.9%). SOFA demonstrated the highest positive predictive value, positive likelihood ratio, diagnostic odds ratio, and overall accuracy in predicting SAP, ICU admission, and mortality. SOFA and Ranson’s score demonstrated the highest area under receiver-operator curves at 48 h in predicting SAP (0.966, 0.857 respectively), ICU admission (0.943, 0.946 respectively), and mortality (0.968, 0.917 respectively).
Overall, the six prognostic indices in this study demonstrated high negative predictive values in prediction of severity, ICU admission and mortality in AP. SOFA score and Ranson score at 48 h are superior to other prognostic scorings (Glasgow score, APACHE II, BISAP, HAPS) in severity stratification, prediction of ICU admission and mortality in AP.
As we provide a retrospective single-center study, future renditions of this study could include multi-center analysis spanning across different countries to reduce bias. Further studies can also compare the utility of trending such scores throughout inpatient stay rather than retrospectively from patients’ results on admission.