Early onset of organ failure is the best predictor of mortality in acute pancreatitis.
BACKGROUND
APACHE II is a multifactorial scoring system for predicting severity in acute pancreatitis (AP). Organ failure (OF) has been correlated with mortality in AP.


OBJECTIVE
To evaluate the usefulness of APACHE II as an early predictor of severity in AP, its correlation with OF, and the relevance of an early establishment of OF during the course of AP.


METHODS
From January 1999 to November 2001, 447 consecutive cases of AP were studied. APACHE II scores and Atlanta criteria were used for defining severity and OF.


RESULTS
Twenty-five percent of patients had severe acute pancreatitis (SAP). APACHE II at 24 h after admission showed a sensitivity, specificity, and positive and negative predictive value of 52, 77, 46, and 84%, respectively, for predicting severity. Mortality for SAP was 20.5%. Seventy percent of patients who developed OF did so within the first 24 hours of admission, and their mortality was 52%. Mortality was statistically significant (p< 0.01) if OF was established within the first 24 hours after admission.


CONCLUSIONS
APACHE II is not reliable for predicting outcome within the first 24 hours after admission and should therefore be used together with other methods. OF mostly develops within the first days after admission, if ever. The time of onset of OF is the most accurate and reliable method for predicting death risk in AP.
Poves Prim
I
I
Department of General and Gastrointestinal Surgery, Hospital Prínceps d'Espanya, Citutat Sanitària i Universitària de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 30023jpp@comb.es
Fabregat Pous
J
J
García Borobia
F J
FJ
Jorba Martí
R
R
Figueras Felip
J
J
Jaurrieta Mas
E
E
D018806:APACHE; D000208:Acute Disease; D006801:Humans; D009102:Multiple Organ Failure / Q000401:mortality*; D010195:Pancreatitis / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate