title: Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis.
abstract: OBJECTIVE
  It is important to identify patients with acute pancreatitis who are at risk for developing persistent organ failure early in the course of disease. Several scoring systems have been developed to predict which patients are most likely to develop persistent organ failure. We head-to-head compared the accuracy of these systems in predicting persistent organ failure, developed rules that combined these scores to optimize predictive accuracy, and validated our findings in an independent cohort.
  
  
  METHODS
  Clinical data from 2 prospective cohorts were used for training (n = 256) and validation (n = 397). Persistent organ failure was defined as cardiovascular, pulmonary, and/or renal failure that lasted for 48 hours or more. Nine clinical scores were calculated when patients were admitted and 48 hours later. We developed 12 predictive rules that combined these scores, in order of increasing complexity.
  
  
  RESULTS
  Existing scoring systems showed modest accuracy (areas under the curve at admission of 0.62-0.84 in the training cohort and 0.57-0.74 in the validation cohort). The Glasgow score was the best classifier at admission in both cohorts. Serum levels of creatinine and blood urea nitrogen provided similar levels of discrimination in each set of patients. Our 12 predictive rules increased accuracy to 0.92 in the training cohort and 0.84 in the validation cohort.
  
  
  CONCLUSIONS
  The existing scoring systems seem to have reached their maximal efficacy in predicting persistent organ failure in acute pancreatitis. Sophisticated combinations of predictive rules are more accurate but cumbersome to use, and therefore of limited clinical use. Our ability to predict the severity of acute pancreatitis cannot be expected to improve unless we develop new approaches.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Rawad
authors.initials: R
authors.lastname: Mounzer
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Langmead
authors.forename: Bechien U
authors.initials: BU
authors.lastname: Wu
authors.forename: Anna C
authors.initials: AC
authors.lastname: Evans
authors.forename: Faraz
authors.initials: F
authors.lastname: Bishehsari
authors.forename: Venkata
authors.initials: V
authors.lastname: Muddana
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.forename: Adam
authors.initials: A
authors.lastname: Slivka
authors.forename: David C
authors.initials: DC
authors.lastname: Whitcomb
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
authors.forename: Peter A
authors.initials: PA
authors.lastname: Banks
authors.forename: Georgios I
authors.initials: GI
authors.lastname: Papachristou
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000209:etiology; D010195:Pancreatitis / Q000150:complications*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index