Different Scoring Systems in Acute Alcoholic Pancreatitis: Which One to Follow? An Ongoing Dilema

Abstract

BACKGROUND: Acute pancreatitis is a common disorder in medical practice. In recent times, management has changed drastically with majority of decisions like intravenous antibiotics, negative suction with Ryle’s tube and surgical interventions like necrosectomy etc based on severity of the disease. There are different scores in use to assess severity of disease but the relative efficacy has remained a debatable subject. OBJECTIVE: The present study was thus done to investigate the predictive accuracy of different scoring systems in acute pancreatitis. METHODS: Fifty patients of acute pancreatitis admitted in medicine ward of Pt. B.D. Sharma PGIMS, Rohtak, India, were taken for study after fulfilling eligibility criteria. These patients were investigated at admission and followed up prospectively. The severity of pancreatitis was classified for each of these patients as per Revised Atlanta System of Classification. Commonly used scoring systems pertaining to acute pancreatitis, viz, BISAP, Ranson, APACHE II and modified computed tomography severity index (CTSI) were calculated. Subsequently these scores were then correlated with severity, presence of organ failure, occurrence of local complications and final outcome of the patients. RESULTS: Out of 50 patients, etiology was chronic alcohol intake in all but one with idiopathic pancreatitis. The mean age of the study population was 42.06±13.27 years. 32% of these patients had pancreatic necrosis, 40% had peripancreatic collections. 56% of them had mild acute pancreatitis, 24% had moderately severe acute pancreatitis, while 20% had severe acute pancreatitis. APACHE II had the highest accuracy in predicting severity, organ failure and fatal outcomes. As far as these parameters were concerned, the negative predictive values of BISAP score were also considerable. Modified CTSI score was accurate in predicting local complications but had limited accuracy in other predictions. CONCLUSION: APACHE II emerged as most reliable scoring system followed by BISAP and Ranson in management of the patients with acute pancreatitis. But in constraints of time and resources, even BISAP score with its significant negative predictive values served as a valuable tool for assessing and managing these patients.

Clinical usefulness of scoring systems to predict severe acute pancreatitis: A systematic review and meta‐analysis with pre and post‐test probability assessment

“…Table 1 presents a summary of relevant studies. The 43 studies 24–65 included 14,116 AP patients, with mean/median age ranging widely (35–72 years) as the rate of male patients (34%–86%).…”

“…Thirty‐four studies (79%) took place in Institutions in Asia, 24–28,30–35,37,39,41–52,54–56,58–62,65 7 in Europe, 36,38,40,53,57,63,64 2 in the USA 9,29 . Twenty‐one studies were prospective, 9,25,29,32–36,38,41,44,45,47,51–54,57,59,61,65 21 retrospective 24,26–28,30,31,37,39,40,42,46,48–50,55,56,58,60,62–64 and 1 cross‐sectional 43 . Three of the studies included both training and validation sets, 9,37,39 and one two cohorts of different age groups 50 .…”

“…There were 42 studies investigating BISAP 9,24–41,43–65 in a total of 13,944 patients. In these studies, the pooled prevalence of severity (pre‐test probability) was 17.8% (14.3%–22.2%) with considerable heterogeneity ( I 2 = 96.9%) (Supplementary Figure ).…”

“…Thirty-four studies (79%) took place in Institutions in Asia, [24][25][26][27][28][30][31][32][33][34][35]37,39,[41][42][43][44][45][46][47][48][49][50][51][52][54][55][56][58][59][60][61][62]65 7 in Europe, 36,38,40,53,57,63,64 2 in the USA. 9,29 Twenty-one studies were prospective, 9,25,29,[32][33][34][35][36]38,…”

Design and validation of a scoring system for rapid identification of severe acute pancreatitis in patients with acute pancreatitis

“…SAP can be diagnosed when patients had an APACHEⅡ score of > 8, and those patients need to be transferred to ICU [12]. Study had shown that APACHE II score is a reliable scoring system, and has high sensitivity for assessing the severity, organ failure and death in AP [13]. However, the APACHEⅡ score can only be determined after 24 hours of admission, and it is a complex system which includes many indicators, and highly depends on laboratory test results, so dynamic determination of disease severity is difficult.…”