Comparison and validation of scoring systems in a cohort of patients treated for biliary acute pancreatitis.
OBJECTIVE
There are a few prospective studies assessing the severity of acute pancreatitis with exclusive criteria for biliary etiology. The aim of this study was to assess the reliability of prediction of the severity and mortality of acute biliary pancreatitis by using the Ranson, Acute Physiology And Chronic Health Evaluation II and III, Simplified Acute Physiology Score II, and Mortality Probability Model (MPM) II systems.


METHODS
Fifty-eight patients with acute biliary pancreatitis were studied prospectively. Disease severity scores and mortality predictions were calculated using the collected data in the first 24 hours of admission and for Ranson score in the first 48 hours. Discrimination and calibration characteristics of each system were determined by using area under receiver operating characteristics curve and Hosmer-Lemeshow goodness-of-fit test, respectively.


RESULTS
Among 58 patients included, there were 4 mortalities (6.8%). Fifteen patients (25.8%) had severe disease, and 5 patients (8.6%) had systemic and local complications. All systems had reliable power of discrimination and calibration. Among systems tested MPM II was the best performing as far as discrimination, and calibration characteristics are considered. The items of MPM II that were positive in patients with severe pancreatitis were those related to systemic perfusion.


CONCLUSIONS
Mortality Probability Model II predicted mortality at admission is better than the other systems in predicting the severity of pancreatitis. Results also indicate the important role of systemic perfusion at the early phases of acute pancreatitis in the progression of disease.
Göçmen
Erdal
E
Fifth Department of Surgery, Ankara Numune Education and Research Hospital, Ankara, Turkey.
Klc
Yusuf Alper
YA
Yoldaş
Omer
O
Ertan
Tamer
T
Karaköse
Nazile
N
Koç
Mahmut
M
Tez
Mesut
M
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001660:Biliary Tract Diseases / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome