[Pleural effusion is superior to multiple factor scoring system in predicting acute pancreatitis outcome].
BACKGROUND
there are many studies about prognostic scores in acute pancreatitis but the best one has yet to be determined.


OBJECTIVE
to analyze the pleural effusion (diagnosed by ultrasound) as a prognostic factor and to compare it with three multiple criteria scores (RANSON, APACHE II, APACHE II O).


METHODS
all patients with acute gallstone pancreatitis were included in the study during the period 2002-2006. Patients treated with ERCP at admission and those in whom ultrasonography was not done were excluded. The severity of the attack was set according to the Atlanta Classification criteria. The prognostic scores used were analyzed to predict separately systemic complications, local complications and total complications (local and systemic). The likelihood positive ratio was used as the most accurate index to compare the prognostic accuracy of the 4 prognostic scores.


RESULTS
178 patients were included. 35 patients were excluded (ERCP at admission=32, ultrasonography not done at admission=3). 29 patients of 143 patients developed severe acute pancreatitis. The pleural effusion evaluated by ultrasonography showed the great accuracy at predicting the development of systemic complications (likelihood positive ratio=6.3), local complications (likelihood positive ratio=11) and total complications (likelihood positive ratio=16.1).


CONCLUSIONS
the pleural effusion evaluated by ultrasonography can predict with great levels of accuracy a severe acute attack. When it was compared with 3 multiple criteria scores (RANSON, APACHE II, APACHE II O) showed to be more accurate at predicting disease severity.
Servicio de Cirugía del Hospital Municipal de Agudos Dr Cosme Argerich, Ciudad Autónoma de Buenos Aires, Argentina. ocampoc@yahoo.com
Carlos
C
Ocampo
Walter
W
Silva
Hugo
H
Zandalazini
Gustavo
G
Kohan
Nicolás
N
Sánchez
Alejandro
A
Oría
D018806:APACHE; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000145:classification / Q000150:complications*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography