Comparison of scoring systems in predicting the severity of acute pancreatitis

doi:10.3748/wjg.v21.i8.2387

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Feb 28, 2015; 21(8): 2387-2394
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2387

Table 1 Characteristics of patients with severe acute pancreatitis n (%)

	Mild to moderately severe AP (n = 140)	Severe AP(n = 21)	P value
Age, yr	62.2 ± 16.5	63.4 ± 13.1	0.968
Male	84 (60.0)	18 (85.7)	0.023
BMI (kg/m²)	23.4 ± 4.4	23.9 ± 4.1	0.607
Hospital visit from symptom onset (d)	5.7 ± 12.8	3.3 ± 6.9	0.388
Etiology
Biliary	78 (55.7)	9 (42.8)	0.270
Alcoholic	26 (18.6)	10 (47.6)	0.030
Idiopathic	33 (23.6)	1 (4.8)	0.130
Others	3 (2.1)	1 (4.8)	0.472
Laboratory finding (initial)
Hematocrit (%)	39.1 ± 6.2	40.3 ± 7.4	0.422
Amylase (IU/L)	1687.9 ± 1415.4	1668.2 ± 1668.8	0.954
Lipase (IU/L)	1949.7 ± 1951.3	2108.2 ± 2750.3	0.744
AST (IU/L)	203.2 ± 240.4	362.6 ± 618.4	0.256
ALT (IU/L)	155.6 ± 182.1	184.7 ± 275.9	0.645
BUN (mg/dL)	14.5 ± 8.6	31.2 ± 32.9	0.031
Creatinine (mg/dL)	1.0 ± 0.5	2.2 ± 1.6	0.003
CRPi (mg/dL)	4.4 ± 6.8	6.9 ± 10.4	0.259
CRP₂₄ (mg/dL)	9.0 ± 7.9	17.4 ± 12.7	0.026
Peripancreatic fluid collection	46 (32.9)	10 (47.6)	0.158
Duration of NPO (d)	4.3 ± 2.2	6.9 ± 5.1	0.038
Hospital stay (d)	8.4 ± 4.8	11.7 ± 6.2	0.008
Scoring systems
Ranson	2.7 ± 1.4	3.7 ± 1.4	0.005
BISAP	1.0 ± 0.8	1.9 ± 0.9	< 0.001
APACHE-II	6.5 ± 3.5	10.8 ± 4.8	< 0.001
CTSI	2.2 ± 1.4	3.5 ± 2.2	< 0.001
Mortality	1 (0.7)	2 (9.5)	0.005

Values are expressed as the mean ± SD. AP: Acute pancreatitis; BMI: Body mass index; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CRPi: C-reactive protein measured at admission; CRP₂₄: C-reactive protein measured after 24 h; NPO: Nil per os; BISAP: Bedside Index for Severity in Acute Pancreatitis; APACHE-II: Acute Physiology and Chronic Health Evaluation-II; CTSI: Computed tomography severity index.

Table 2 Correlation analysis of various scoring systems

		Ranson	BISAP	APACHE-II	CTSI	CRPi	CRP₂₄
Ranson	r	1	0.58	0.60	-0.03	0.28	0.22
Ranson	P-value		< 0.001	< 0.001	0.693	0.001	0.045
BISAP	r		1	0.54	-0.05	0.33	0.28
BISAP	P-value			< 0.001	0.498	< 0.001	0.009
APACHE-II	r			1	-0.01	0.32	0.37
APACHE-II	P-value				0.905	< 0.001	< 0.001
CTSI	r				1	0.07	0.44
CTSI	P-value					0.427	< 0.001
CRPi	r					1	0.59
CRPi	P-value						< 0.001
CRP₂₄	r						1
	P-value

BISAP: Bedside Index for Severity in Acute Pancreatitis; APACHE-II: Acute Physiology and Chronic Health Evaluation-II; CTSI: Computed tomography severity index; CRPi: C-reactive protein measured at admission; CRP₂₄: C-reactive protein measured after 24 h.

Table 3 Incidence of severe acute pancreatitis stratified according to bedside index for severity in acute pancreatitis, Ranson, Acute Physiology and Chronic Health Evaluation-II, computed tomography severity index, and C-reactive protein with corresponding odds ratio n (%)

	Patients	Severe AP
Ranson
< 2	65 (40.4)	3 (4.6)
≥ 3	96 (59.6)	18 (18.8)
OR (95%CI)		4.8 (1.3-16.9)
BISAP
< 1	109 (67.7)	8 (7.3)
≥ 2	52 (22.3)	13 (25.0)
OR (95%CI)		4.2 (1.6-10.9)
APACHE-II
< 7	65 (40.4)	4 (6.2)
≥ 8	96 (59.6)	17 (17.7)
OR (95%CI)		8.2 (2.6-25.6)
CTSI
< 2	101 (62.7)	7 (6.9)
≥ 3	60 (37.3)	14 (23.3)
OR(95%CI)		4.1 (1.5-10.8)
CRP₂₄
< 21.4	72 (85.7)	6 (8.3)
≥ 21.4	12 (14.3)	8 (66.7)
OR (95%CI)		22.0 (5.1-95.0)

AP: Acute pancreatitis; BISAP: Bedside Index for Severity in Acute Pancreatitis; APACHE-II: Acute Physiology and Chronic Health Evaluation-II; CTSI: Computed tomography severity index; CRP₂₄: C-reactive protein measured after 24 h.

Table 4 Sensitivity, specificity, positive predictive value, and negative predictive value of different scoring systems in prediction of severe acute pancreatitis

	Sensitivity (95%CI)	Specificity (95%CI)	PPV (95%CI)	NPV (95%CI)
Ranson	85.7 (63.7-97.0)	44.3 (35.9-52.9)	18.8 (11.5-28.0)	95.3 (87.1-99.0)
BISAP	61.9 (38.4-81.9)	72.1 (63.9-79.4)	25.0 (14.0-38.9)	92.7 (86.0-96.8)
APACHE-II	81.0 (58.1-94.6)	65.7 (57.2-73.5)	26.2 (16.0-38.5)	95.8 (89.7-98.9)
CTSI	66.7 (43.0-85.4)	67.1 (58.7-74.8)	23.3 (13.4-36.0)	93.1 (86.2-97.2)
CRP₂₄	53.3 (26.6-78.7)	94.3 (86.0-98.4)	66.7 (34.9-90.1)	90.4 (81.2-96.1)

AP: Acute pancreatitis; PPV: Positive predictive value; NPV: Negative predictive value; BISAP: Bedside Index for Severity in Acute Pancreatitis; APACHE-II: Acute Physiology and Chronic Health Evaluation-II; CTSI: Computed tomography severity index; CRP₂₄: C-reactive protein measured after 24 h.

Citation: Cho JH, Kim TN, Chung HH, Kim KH. Comparison of scoring systems in predicting the severity of acute pancreatitis. World J Gastroenterol 2015; 21(8): 2387-2394
URL: https://www.wjgnet.com/1007-9327/full/v21/i8/2387.htm
DOI: https://dx.doi.org/10.3748/wjg.v21.i8.2387