Comparison of scoring systems in predicting the severity of acute pancreatitis.
OBJECTIVE
To investigate the prognostic usefulness of several existing scoring systems in predicting the severity of acute pancreatitis (AP).


METHODS
We retrospectively analyzed the prospectively collected clinical database from consecutive patients with AP in our institution between January 2011 and December 2012. Ranson, Acute Physiology and Chronic Health Evaluation (APACHE)-II, and bedside index for severity in acute pancreatitis (BISAP) scores, and computed tomography severity index (CTSI) of all patients were calculated. Serum C-reactive protein (CRP) levels were measured at admission (CRPi) and after 24 h (CRP24). Severe AP was defined as persistent organ failure for more than 48 h. The predictive accuracy of each scoring system was measured by the area under the receiver-operating curve (AUC).


RESULTS
Of 161 patients, 21 (13%) were classified as severe AP, and 3 (1.9%) died. Statistically significant cutoff values for prediction of severe AP were Ranson≥3, BISAP≥2, APACHE-II≥8, CTSI≥3, and CRP24≥21.4. AUCs for Ranson, BISAP, APACHE-II, CTSI, and CRP24 in predicting severe AP were 0.69 (95%CI: 0.62-0.76), 0.74 (95%CI: 0.66-0.80), 0.78 (95%CI: 0.70-0.84), 0.69 (95%CI: 0.61-0.76), and 0.68 (95%CI: 0.57-0.78), respectively. APACHE-II demonstrated the highest accuracy for prediction of severe AP, however, no statistically significant pairwise differences were observed between APACHE-II and the other scoring systems, including CRP24.


CONCLUSIONS
Various scoring systems showed similar predictive accuracy for severity of AP. Unique models are needed in order to achieve further improvement of prognostic accuracy.
Joon Hyun Cho, Tae Nyeun Kim, Hyun Hee Chung, Kook Hyun Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea.
Joon Hyun
JH
Cho
Joon Hyun Cho, Tae Nyeun Kim, Hyun Hee Chung, Kook Hyun Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea.
Tae Nyeun
TN
Kim
Joon Hyun Cho, Tae Nyeun Kim, Hyun Hee Chung, Kook Hyun Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea.
Hyun Hee
HH
Chung
Joon Hyun Cho, Tae Nyeun Kim, Hyun Hee Chung, Kook Hyun Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 705-717, South Korea.
Kook Hyun
KH
Kim
D018806:APACHE; D000208:Acute Disease; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D056910:Republic of Korea; D012189:Retrospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D002097:C-Reactive Protein
Acute pancreatitis; Predictors; Scoring systems; Severe acute pancreatitis; Severity