Validation of the modified Ranson versus Glasgow score for pancreatitis in a Singaporean population.
BACKGROUND
The characteristics of patients with acute pancreatitis in multi-ethnic Singapore differ from that of the populations used in formulating the modified Ranson and Glasgow scores. The use of these scoring systems has not previously been validated in the Singaporean setting. This study aims to validate and compare the prognostic use of the modified Ranson and Glasgow scores, and to determine the superiority of one score over the other in predicting the outcome for acute pancreatitis in the Singaporean population.


METHODS
This is a 3-year retrospective study of patients diagnosed with acute pancreatitis at our centre. Patients with chronic pancreatitis, acute on chronic pancreatitis, iatrogenic pancreatitis, pancreatic cancer as well as those with incomplete Ranson or Glasgow scores were excluded from the study. Case notes and computer records were reviewed for local complications of pancreatitis and organ failure. Receiver operator characteristic (ROC) curves of the Ranson and Glasgow scores were plotted for the prediction of severity and mortality.


RESULTS
Between January 2010 and December 2012, 230 cases were diagnosed with acute pancreatitis. A majority of the patients had mild pancreatitis (n = 194, 84.3%), and the overall 30-day mortality rate was 3.5% (n = 8). ROC of the Ranson and Glasgow scoring systems for mortality showed an area under curve (AUC) of 0.854 (P = 0.001) and 0.776 (P = 0.008), respectively. For severity, the AUC for the modified Ranson and Glasgow score was calculated to be 0.694 and 0.668, respectively.


CONCLUSIONS
The ROC curves of Ranson and Glasgow scores for mortality are comparable with that published in earlier studies. In a Singaporean population, the Ranson score is more accurate in the prediction of mortality. However, both scoring systems are poor predictors for severity of acute pancreatitis.
Department of Surgery, Changi General Hospital, Singapore.
Yong Hui Alvin
YHA
Tan
Department of Surgery, Changi General Hospital, Singapore.
Shumaila
S
Rafi
Department of Surgery, Changi General Hospital, Singapore.
Mirriam
M
Tyebally Fang
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Stephen
S
Hwang
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Ee Wen
EW
Lim
Department of Surgery, Changi General Hospital, Singapore.
James
J
Ngu
Department of Surgery, Changi General Hospital, Singapore.
Su-Ming
SM
Tan
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009336:Necrosis / Q000150:complications*; D010195:Pancreatitis / Q000150:complications* / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012846:Singapore / Q000208:ethnology; D055815:Young Adult
general surgery; hepatopancreaticobiliary surgery; pancreas; pancreatitis