APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis.
BACKGROUND
It has been suggested that addition of obesity score to the APACHE-II system can lead to more accurate prediction of severity of acute pancreatitis. However there is scanty information on the usefulness of the combined APACHE-O scoring system in Asian patients. This study aimed to compare the accuracy of Ranson, APACHE-II and APACHE-O systems in assessing severity of acute pancreatitis in a local Chinese population.


METHODS
One hundred and one consecutive patients with acute pancreatitis were prospectively studied. Body mass index (BMI) was measured on admission. Ranson score, APACHE-II and APACHE-O scores were recorded on admission and at 48 hours. By adopting the cut-off levels and definitions advocated in the Atlanta consensus for severe disease, the diagnostic accuracy of the three scoring systems was compared by the area under the curve (AUC) under the receiver operator characteristic curve.


RESULTS
Of the 101 patients, 12 (11.9%) patients suffered from severe pancreatitis. Obesity was uncommon and only two patients (2.0%) had BMI>30. Eighty-two (81.2%) patients were normal weight (BMI< or =25) whereas 17 (16.8%) were overweight (BMI 25-30). Overweight or obesity (BMI>25) was not associated with severe pancreatitis (P=0.40). The AUC for admission scores of Ranson, APACHE-II, and APACHE-O systems was 0.549, 0.904 and 0.904, respectively. The AUC for 48-hour scores of Ranson, APACHE-II and APACHE-O systems was 0.808, 0.955 and 0.951, respectively.


CONCLUSIONS
The APACHE-II scoring system is more accurate than the Ranson scoring system of the prediction of severity in acute pancreatitis. Addition of obesity score does not significantly improve the predictive accuracy of the APACHE-II system in our local population with a low prevalence of obesity.
Yeung
Yuk Pang
YP
Department of Surgery, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong, China. yeungyp@yahoo.com
Lam
Billy Yeung Kit
BY
Yip
Andrew Wai Chun
AW
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015992:Body Mass Index; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis* / Q000628:therapy; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index