Comparison of scoring systems in predicting the severity of acute pancreatitis

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: Acute pancreatitis; Predictors; Scoring systems; Severe acute pancreatitis; Severity.

Figure 1

Receiver-operating characteristic curves of different scoring systems and C-reactive protein in prediction of severe acute pancreatitis. BISAP: Bedside Index for Severity in Acute Pancreatitis; APACHE: Acute Physiology and Chronic Health Examination; CTSI: Computed tomography severity index; CRPi: C-reactive protein measured at admission; CRP₂₄: C-reactive protein measured after 24 h.