title: The Acute Physiology and Chronic Health Evaluation IV, a New Scoring System for Predicting Mortality and Complications of Severe Acute Pancreatitis.
abstract: OBJECTIVE
  Severe acute pancreatitis is associated with significant morbidity/mortality; thus, the ability to predict hospital course is imperative. An updated version of the Acute Physiology and Chronic Health Evaluation II (APACHE), APACHE IV, has recently been validated. Unlike other versions, APACHE IV uses hepatobiliary parameters and accounts for multiple comorbid conditions and sedation. The intention of this study was to examine APACHE IV for predicting mortality and secondary outcomes for pancreatitis in a prospective cohort. In addition, we compared APACHE IV to APACHE II, Bedside Index for Severity in Acute Pancreatitis, and Ranson criterion.
  
  
  METHODS
  We prospectively collected physiologic parameters for each scoring system in 266 patients with severe acute pancreatitis from August 2011 to April 2014. Prognostic value of each score was determined using the area under the receiver operating characteristic curve.
  
  
  RESULTS
  Among 266 patients, 59% were men, 52% were white, and 36.5% had alcohol-induced pancreatitis. Mortality occurred in 15 (5.6%), and an APACHE IV of 44 or greater predicted mortality in 100% of cases. The receiver operating characteristic curve for APACHE IV was 0.93 (confidence interval [CI], 0.88-0.97); APACHE II, 0.87 (CI, 0.80-0.94); Bedside Index for Severity in Acute Pancreatitis, 0.86 (CI, 0.78-0.94); and Ranson criterion, 0.90 (CI, 0.94-0.96).
  
  
  CONCLUSIONS
  The APACHE IV is a valid means for predicting mortality and disease-related complications in acute pancreatitis.
authors.affiliation: From the Division of Gastroenterology and Liver Diseases, Department of Medicine, Cooper University Hospital, Camden, NJ.
authors.forename: Shaffer R S
authors.initials: SR
authors.lastname: Mok
authors.forename: Sachin
authors.initials: S
authors.lastname: Mohan
authors.forename: Adam B
authors.initials: AB
authors.lastname: Elfant
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Judge
mesh_terms: D018806:APACHE; D000208:Acute Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010195:Pancreatitis / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D015996:Survival Rate