Prediction of mortality in acute pancreatitis: a systematic review of the published evidence.
OBJECTIVE
In this review, we focus on studies that examined such prognostic indices in relation to predicting a fatal outcome from pancreatitis.


BACKGROUND
Acute pancreatitis (AP) is a common emergency, and early identification of high-risk patients can be difficult. For this reason, a plethora of different prognostic variables and scoring systems have been assessed to see if they can reliably predict the severity of pancreatitis and/or subsequent mortality.


METHODS
All studies that focused on AP, including retrospective series and prospective trials, were retrieved and analysed for factors that could influence mortality. Articles that analysed factors influencing the severity of the disease or the manifestation of disease-related complications were excluded.


RESULTS
58 articles meeting the inclusion criteria were identified. Among the various factors investigated, APACHE II seemed to have the highest positive predictive value (69%). However, most prognostic variables and scores showed high negative predictive values but suboptimal values for positive predictive power.


CONCLUSIONS
Despite the proliferation of scoring systems for grading AP, none are ideal for the prediction of mortality. With the exception of the APACHE II, the other scores and indexes do not have a high degree of sensitivity, specificity and predictive values.
Gravante
G
G
Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK. gg43@le.ac.uk
Garcea
G
G
Ong
S L
SL
Metcalfe
M S
MS
Berry
D P
DP
Lloyd
D M
DM
Dennison
A R
AR
D018806:APACHE; D000208:Acute Disease; D006801:Humans; D017063:Outcome Assessment, Health Care; D010195:Pancreatitis / Q000175:diagnosis / Q000401:mortality*; D019283:Pancreatitis, Acute Necrotizing / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index