The Pancreatitis Outcome Prediction (POP) Score: a new prognostic index for patients with severe acute pancreatitis.
OBJECTIVE
Severe acute pancreatitis, defined as pancreatitis with distant organ dysfunction, is a condition carrying a high mortality and morbidity. Current outcome prediction scores are based on small populations, usually from single specialist centers. Some scores cannot be applied until several days into hospital admission. We thus sought to develop a new and more sensitive outcome prediction score--the Pancreatitis Outcome Prediction (POP) Score--for these high-risk patients.


METHODS
Retrospective cohort study of a large multicenter intensive care database.


METHODS
One hundred fifty-nine U.K. intensive care units.


METHODS
Participants were 2,462 patients admitted to intensive care units with severe acute pancreatitis.


METHODS
None.


RESULTS
Demographic, physiologic, and biochemical data collected within the first 24 hrs of intensive care unit admission were used to develop a risk prediction score using logistic regression. The six variables with the strongest relationship to hospital outcome--arterial pH, age, serum urea, mean arterial pressure, PaO2/FIO2 ratio, and total serum calcium (in order of decreasing impact)--produced a model with a prognostic discrimination (area under the receiver operating characteristic curve = 0.838) superior to other models. These six factors were used to develop an objectively weighted multivariate prognostic score ranging from 0 to 40 points.


CONCLUSIONS
Prognostic stratification of patients with severe acute pancreatitis requiring intensive care offers a useful audit tool to gauge unit performance and improve delineation of subsets for prospective trials. Prospective validation of this new outcome prediction score is required, preferably in different countries. The validity of the POP Score for either hospital or intensive care admission could also be tested and assessed for superiority over existing scores.
Harrison
David A
DA
Intensive Care National Audit & Research Centre, Tavistock House, Tavistock Square, London, United Kingdom. david.harrison@icnarc.org
D'Amico
Giovanna
G
Singer
Mervyn
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000175:diagnosis*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D006113:United Kingdom