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Canadian Journal of Gastroenterology and Hepatology
Volume 29, Issue 6, Pages 299-303
http://dx.doi.org/10.1155/2015/392643
Original Article

Comparative Analysis of Selected Scales to Assess Prognosis in Acute Pancreatitis

Dorota Koziel,2 Stanislaw Gluszek,1,2 Jaroslaw Matykiewicz,1,2 Piotr Lewitowicz,2 and Zuzanna Drozdzak3

1Clinical General, Oncological and Endocrinological Surgery, Regional Hospital, Poland
2Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
3Centre for Evaluation and Analysis of Public Policies, Jagiellonian University, Cracow, Poland

Received 16 October 2014; Accepted 3 February 2015

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

OBJECTIVE: To evaluate the utility of selected scales to prognosticate the severity and risk for death among patients with acute pancreatitis (AP) according to the revised Atlanta classification published in 2012.

METHODS: Prospective data regarding patients hospitalized due to AP were analyzed. The final analysis included a total of 1014 patients. The bedside index for severity in acute pancreatitis (BISAP), Panc 3 scores and Ranson scales were calculated using data from the first 24 h of admission.

RESULTS: Mild AP was diagnosed in 822 (81.1%) cases, moderate in 122 (12%) and severe in 70 (6.9%); 38 (3.7%) patients died. The main causes of AP were cholelithiasis (34%) and alcohol abuse (26.7%). Recurrence of AP was observed in 244 (24.1%) patients. In prognosticating the severity of AP, the most useful scale proved to be the Acute Physiology and Chronic Health Evaluation (APACHE) II (area under the curve [AUC] 0.724 [95% CI 0.655 to 0.793]), followed by BISAP (AUC 0.693 [95% CI 0.622 to 0.763]). In prognosticating a moderate versus mild course of AP, the CT severity index proved to be the most decisive (AUC 0.819 [95% CI 0.767 to 0.871]). Regarding prognosis for death, APACHE II had the highest predictive value (AUC 0.726 [95% CI 0.621 to 0.83]); however, a similar sensitivity was observed using the BISAP scale (AUC 0.707 [95% CI 0.618 to 0.797]).

CONCLUSIONS: Scoring systems used in prognosticating the course of the disease vary with regard to sensitivity and specificity. The CT severity index scoring system showed the highest precision in prognosticating moderately severe AP (as per the revised Atlanta criteria, 2012); however, in prognosticating a severe course of disease and mortality, APACHE II proved to have the greatest predictive value.