Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis

Abstract

SUMMARY Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis BACKGROUND/AIMS To compare radiological scoring systems, clinical scores, serum C-reactive protein (CRP) levels and the neutrophil-lymphocyte ratio (NLR) for predicting the severity and mortality of acute pancreatitis (AP). MATERIALS AND METHODS Demographic, clinical, and radiographic data from 80 patients with AP were retrospectively evaluated. The harmless acute pancreatitis score (HAPS), systemic inflammatory response syndrome (SIRS), bedside index for severity in acute pancreatitis (BISAP), Ranson score, Balthazar score, modified computed tomography severity index (CTSI), extrapancreatic inflammation on computed tomography (EPIC) score and renal rim grade were recorded. The prognostic performance of radiological and clinical scoring systems, NLR at admission, and serum CRP levels at 48 hours were compared for severity and mortality according to the revised Atlanta Criteria. The data were evaluated by calculating the receiver operator characteristic (ROC) curves and area under the ROC (AUROC). RESULTS Out of 80 patients, 19 (23.8%) had severe AP, and 9 (11.3%) died. The AUROC for the BISAP score was 0.836 (95%CI: 0.735-0.937), with the highest value for severity. With a cut-off of BISAP ≥2, sensitivity and specificity were 68.4% and 78.7%, respectively. The AUROC for NLR was 0.915 (95%CI: 0.790-1), with the highest value for mortality. With a cut-off of NLR >11.91, sensitivity and specificity were 76.5% and 94.1%, respectively. Of all the radiological scoring systems, the EPIC score had the highest AUROC, i.e., 0.773 (95%CI: 0.645-0.900) for severity and 0.851 (95%CI: 0.718-0.983) for mortality, with a cut-off value ≥6. CONCLUSION The BISAP score and NLR might be preferred as early determinants of severity and mortality in AP. The EPIC score might be suggested from the current radiological scoring systems.

Comparative evaluation of BISAP score and computed tomography severity index as a predictor for severity of acute pancreatitis

“…The most common cause of pancreatitis was gallstone followed by alcoholism. [4][5][6][7] We observed severe acute pancreatitis (SAP) in 24 patients (25%) of the 96 patients. SAP was present in 57 patients (59.4%) and 63 patients (65.6%) according to BISAP and CTSI score respectively.…”

Pleural effusion volume in patients with acute pancreatitis: a retrospective study from three acute pancreatitis centers

“…In another study by Gezer et al. [ 36 ], they stated that with a cut-off of BISAP score ≥2.0, the BISAP score hold the highest value for severity of AP; whereas with a cut-off of >11.91, the neutrophil-lymphocyte ratio (NLR) shared the highest value for mortality of AP. Of all the radiological scoring systems (the Balthazar, modified CTSI, and EPIC score were included in that study), and with a cut-off value ≥6.0, the EPIC score had the highest AUC (0.773, 95% CI: 0.645–0.900) for severity and 0.851 (95% CI: 0.718–0.983) for mortality.…”

Serum chitotriosidase and YKL-40 in acute pancreatitis: Reliability as prognostic marker for disease severity and correlation with inflammatory markers

“…To achieve these goals, the determination of inflammatory activity has considerable prognostic relevance. Apart from clinical assessments, biochemical and radiological evaluations are commonly used to determine the presence and the severity of pancreatic inflammation [2,22]. Unfortunately, determining AP severity in the early phases of the disease is still challenging and depends chiefly on analyzing different clinical and biochemical variables.…”