A comparison of APACHE II, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification

Abstract

ObjectiveOur aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Bedside Index of Severity in Acute Pancreatitis (BISAP), Ranson’s score and modified Computed Tomography Severity Index (CTSI) in predicting the severity of acute pancreatitis based on Atlanta 2012 definitions in a tertiary care hospital in northern India.MethodsFifty patients with acute pancreatitis admitted to our hospital during the period of March 2015 to September 2016 were included in the study. APACHE II, BISAP and Ranson’s score were calculated for all the cases. Modified CTSI was also determined based on a pancreatic protocol contrast enhanced computerized tomography (CT). Optimal cut-offs for these scoring systems and the area under the curve (AUC) were evaluated based on the receiver operating characteristics (ROC) curve and these scoring systems were compared prospectively.ResultsOf the 50 cases, 14 were graded as severe acute pancreatitis. Pancreatic necrosis was present in 15 patients, while 14 developed persistent organ failure and 14 needed intensive care unit (ICU) admission. The AUC for modified CTSI was consistently the highest for predicting severe acute pancreatitis (0.919), pancreatic necrosis (0.993), organ failure (0.893) and ICU admission (0.993). APACHE II was the second most accurate in predicting severe acute pancreatitis (AUC 0.834) and organ failure (0.831). APACHE II had a high sensitivity for predicting pancreatic necrosis (93.33%), organ failure (92.86%) and ICU admission (92.31%), and also had a high negative predictive value for predicting pancreatic necrosis (96.15%), organ failure (96.15%) and ICU admission (95.83%).ConclusionAPACHE II is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for tertiary care during the course of their illness and therefore need early resuscitation and prompt referral, especially in resource-limited developing countries.

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

“…APACHEⅡ score is the most widely accepted and used scoring system, and is also a highly recommended scoring system by many guidelines [11]. 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].…”

Review of Current Evidence in the etiopathogenesis, epidemiology, diagnosis and management of acute pancreatitis

“…A score ≥ 8 is considered as a risk of death, and the risk is greater as the score increases. The APACHE-O is used when the obesity factor is added to the score [57][58][59][60]. c) Modified Glasgow Criteria (Imrie): Has sensitivity of 80% when used in the first 48 hours.…”

“…There are other scoring systems such as: i) Determinant-Based System: It is based on the identification of radiological changes of the collections, sterile PAN or infected and organ failure signs [66]. j) Severity index by CT: Sums the Balthazar degree, more the degree of necrosis [56,58,62,67]. Evaluates the presence of peripancreatic inflammation, phlegmon, and necrosis.…”

“…In the first 24 hours includes clinical suspicion, an increase of BMI, pleural effusion and increased APACHE value II. After 24 hours it includes persistent organ failure and/or Glasgow Imrie> 3 and higher severity score if CRP >150 mg/L or increased biomarkers IL-1, IL-6, IL-8, IL-10, procalcitonin and beta-receptor antagonist [45,46,58,63,68]. l) EPIC: Evaluates the presence of ascites, pleural effusion, and retroperitoneal edema.…”

Is It All Clear if Procalcitonin Clears in Acute Pancreatitis?

“…Hence, it is a reliable predictor of outcome. 4 Chatzicostas et al compared Ranson's score, APACHE II, and III and found all the three had similar predictability. 5 Recently, APACHE II and APACHE IV scores have been compared with a cutoff of 8 and 45, respectively, and the latter has a better diagnostic capacity than APACHE II, BISAP, and Ranson's criteria.…”