Prediction of outcome in acute pancreatitis: A comparative study of APACHE II, clinical assessment and multiple factor scoring systems

Abstract

The APACHE II severity of disease classification system has been examined prospectively in 160 patients with acute pancreatitis. Using clinical and simple laboratory data APACHE II was able to provide useful discrimination between uncomplicated, complicated and fatal attacks within a few hours of admission. Peak APACHE II scores (recorded during the first 3 days) had a prognostic accuracy similar to the multiple factor scoring systems, but then incurred a similar delay. Patients could be graded according to their risk of death or of developing a major complication; no deaths occurred in patients with a peak APACHE II score less than 10. APACHE II can be repeated daily, uncomplicated attacks demonstrating falling scores in association with clinical improvement, in contrast to the rising scores associated with clinical deterioration in those dying early. APACHE II appears to reflect any continuing disease activity and may prove a useful means of monitoring the course of the illness and response to therapy.

Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?

“…Indeed no mortality was reported in low CTSI scores whereas a 17% mortality was associated with high scores. However, the usefulness appears questionable for clinical management of patients with an intermediate score (3)(4)(5)(6) that is associated with a 6% mortality rate. Indeed in our patient population, even with an optimized cutoff point, the sensitivity does not exceed 80% with a specificity of 55% (Table 4).…”

“…Indeed predicting the severity of acute pancreatitis remains a cornerstone, as no simple and effective diagnostic tool is available yet. None of the present criteria allows to predict the severity of acute pancreatitis with sufficient accuracy (clinical Ranson, Acute Physiology and Chronic Health Evaluation-APACHE II, modified Glasgow and Balthazar radiological scores) [4][5][6]. In addition, no specific management and therapeutical approach have emerged.…”

Assessment of the severity in 350 patients of acute pancreatitis by contrast enhanced computerized tomography

“…[3] Clinical assessment by the clinician is poor in predicting the severity of acute pancreatitis on admission, and it fails to identify up to two-thirds of patients, who eventually develop complications or die. [4] Beneficial results have been obtained with the early management of patients, correctly classified as severe, in intensive care units, with early endoscopic retrograde cholangiopancreatography (ERCP) and biliary drainage in gallstoneinduced disease and prophylactic antibiotics. [5] Criticism of the Atlanta severity classification system is growing, however, because it is retrospective, the duration of organ failure is unspecified, and because local complications do not seem to increase mortality.…”

Acute Pancreatitis: Presentation and Risk Assessment

“…The system is comparatively complex and more difficult to perform because 12 different physiologic measurements are used (Larvin 1989). The higher the total score, the more severe the episode of acute pancreatitis, which corresponds to an increase in predicted morbidity and mortality (Wilson et al 1990). One major advantage of the APACHE-II numeric system compared with other systems is that it can be used throughout the patient's hospital course, aiding evaluation and monitoring of response to therapy.…”

“…The APACHE-II is valid for repeated measures throughout hospitalization and it represents a universal measurement of disease severity, obviating the need for a separate score for acute pancreatitis. The APACHE II performs very well as a prognostic tool, with sensitivity and specificity rates of 75% and 92% respectively (Wilson et al 1990). …”