The panc 3 score: a rapid and accurate test for predicting severity on presentation in acute pancreatitis.
OBJECTIVE
The goal of our study was to develop a simple rule that could rapidly identify those at risk for severe acute pancreatitis (SAP) in the ER.


METHODS
We identified all published studies reporting risk factors for SAP. We identified 3 risk factors which had been shown to predict SAP. The risk factors we identified were a serum hematocrit greater than 44 mg/dL, a body mass index (BMI) greater than 30 mg/kg, and a chest x-ray which reveals a pleural effusion (Panc 3 criteria). We computed the test-operating characteristics and likelihood ratios for each risk factor using the patients originally sampled in each of the studies (n=393). For validation, we examined Panc 3's ability to predict SAP in patients seen at our medical center [University of North Carolina at Chapel Hill (UNC) hospitals n=238].


RESULTS
The likelihood ratios positive and negative for HCT, BMI>30 kg/M, and a chest x-ray with a pleural effusion were 14, 9.8, and 8.7, respectively, for the original data and 178, 2.4, and 1.3 for the UNC data. Sensitivity analysis revealed satisfaction of the HCT, BMI, and pleural effusion criteria had a posttest likelihood of disease 99% when the pretest probability of disease varied from 12-25%. These values were true for the original and UNC data.


CONCLUSIONS
The Panc 3 score is easy to use and accurate for the prediction of SAP. The serum HCT was the strongest predictor of SAP. The combination of the Panc 3 variables was highly predictive of SAP.
Brown
Alphonso
A
Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, Dana Research Building, 330 Brookline Avenue, Boston, MA, USA.
James-Stevenson
Toyia
T
Dyson
Tara
T
Grunkenmeier
David
D
D000208:Acute Disease; D015992:Body Mass Index; D006400:Hematocrit; D006801:Humans; D016013:Likelihood Functions; D010195:Pancreatitis / Q000175:diagnosis* / Q000503:physiopathology; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index