Prognostic usefulness of scoring systems in critically ill patients with severe acute pancreatitis

Abstract

Objective: To compare prognostic scoring systems in a retrospective series of patients with severe acute pancreatitis admitted to a surgical intensive care unit (ICU).

Method: Between January 1992 and December 1996, the charts of all patients with a discharge code of acute pancreatitis were reviewed. There were 273 charts reviewed. Of these, 12 were admitted to the surgical ICU with a diagnosis of severe acute pancreatitis. A preliminary analysis of the data considers descriptive summary statistics, such as the mean and the range. The Spearman's rank-correlation test was computed to assess concordance between the following: a) length of stay and Ranson criteria; b) length of stay and Acute Physiology and Chronic Health Evaluation (APACHE) III score; and c) length of stay and modified Glasgow Coma score. Also, an unpaired t-test was used to obtain concordance between the following: a) death and Ranson; b) death and APACHE III; and c) death and modified Glasgow Coma score.

Results: The prognostic score for APACHE III, Ranson criteria, and modified Glasgow Coma score were compared with the patients' length of stay. Patients who had >5 Ranson criteria, modified Glasgow Coma scores of >4, and APACHE III scores of >30 at 96 hrs (mean 71+/-16 [SD]; p < .0) subsequently died. These two patients were excluded from the Spearman's rank-correlation tests. The mean length of stay in our sample was 61.8 (range, 7-201) days. The mean Ransom criteria was 4.3 (range, 1-9). The mean 96-hr APACHE III score was 33.3 (range, 0-83). The Spearman's rank-correlation between length of stay and Ranson criteria was 0.68, with a corresponding p value of .03. Similar results were observed for the length of stay and APACHE III at 96 hrs (correlation, 0.77; p = .0098) and the length of stay and the modified (correlation, 0.78; p = .007). These data reveal that the magnitude of correlation between the length of stay and the 96-hr APACHE III and modified Imrie is larger than that between length of stay and Ranson criteria.

Conclusions: Once a patient is admitted to the surgical ICU, several predictors of mortality or complications that will require long hospitalization times are evident. In this sample of patients, APACHE III scores >30 at 96 hrs, 5 or more Ranson criteria, and a modified Imrie (Glasgow) score of >3 predicted those who died or had multiple complications. Those patients with combined 48-hr and 96-hr APACHE III scores of >60 either died or had hospitalizations of >60 days. These patients had major pancreatic complications that included pancreatic necrosis, pancreatic abscess, pseudocyst, hemorrhagic pancreatitis, and pancreatic ascites.