The Pancreatitis Outcome Prediction (POP) Score: a new prognostic index for patients with severe acute pancreatitis

Abstract

Objective: Severe acute pancreatitis, defined as pancreatitis with distant organ dysfunction, is a condition carrying a high mortality and morbidity. Current outcome prediction scores are based on small populations, usually from single specialist centers. Some scores cannot be applied until several days into hospital admission. We thus sought to develop a new and more sensitive outcome prediction score--the Pancreatitis Outcome Prediction (POP) Score--for these high-risk patients.

Design: Retrospective cohort study of a large multicenter intensive care database.

Setting: One hundred fifty-nine U.K. intensive care units.

Patients: Participants were 2,462 patients admitted to intensive care units with severe acute pancreatitis.

Interventions: None.

Measurements and main results: Demographic, physiologic, and biochemical data collected within the first 24 hrs of intensive care unit admission were used to develop a risk prediction score using logistic regression. The six variables with the strongest relationship to hospital outcome--arterial pH, age, serum urea, mean arterial pressure, PaO2/FIO2 ratio, and total serum calcium (in order of decreasing impact)--produced a model with a prognostic discrimination (area under the receiver operating characteristic curve = 0.838) superior to other models. These six factors were used to develop an objectively weighted multivariate prognostic score ranging from 0 to 40 points.

Conclusions: Prognostic stratification of patients with severe acute pancreatitis requiring intensive care offers a useful audit tool to gauge unit performance and improve delineation of subsets for prospective trials. Prospective validation of this new outcome prediction score is required, preferably in different countries. The validity of the POP Score for either hospital or intensive care admission could also be tested and assessed for superiority over existing scores.