Waterlow score as a surrogate marker for predicting adverse outcome in acute pancreatitis

Abstract

Introduction Introduced originally to stratify risk for developing decubitus ulcers, the Waterlow scoring system is recorded routinely for surgical admissions. It is a composite score, reflecting patients’ general condition and co-morbidities. The aim of this study was to investigate whether the Waterlow score can be used as an independent surrogate marker to predict severity and adverse outcome in acute pancreatitis. Methods In this retrospective analysis, a consecutive cohort was studied of 250 patients presenting with acute pancreatitis, all of whom had their Waterlow score calculated on admission. Primary outcome measures were length of hospital stay and mortality. Secondary outcome measures included rate of intensive care unit (ICU) admission and development of complications such as peripancreatic free fluid, pancreatic necrosis and pseudocyst formation. Correlation of the Waterlow score with some known markers of disease severity and outcomes was also analysed. Results The Waterlow score correlated strongly with the most commonly used marker of disease severity, the Glasgow score (analysis of variance, p=0.0012). Inpatient mortality, rate of ICU admission and length of hospital stay increased with a higher Waterlow score (Mann–Whitney U test, p=0.0007, p=0.049 and p=0.0002 respectively). There was, however, no significant association between the Waterlow score and the incidence of three known complications of pancreatitis: presence of peripancreatic fluid, pancreatic pseudocyst formation and pancreatic necrosis. Receiver operating characteristic curve analysis demonstrated good predictive power of the Waterlow score for mortality (area under the curve [AUC]: 0.73), ICU admission (AUC: 0.65) and length of stay >7 days (AUC: 0.64). This is comparable with the predictive power of the Glasgow score and C-reactive protein. Conclusions The Waterlow score for patients admitted with acute pancreatitis could provide a useful tool in prospective assessment of disease severity, help clinicians with appropriate resource management and inform patients.

Validity of the Adapted Waterlow Score as a Tool in Predicting Adverse Outcomes in Acute Pancreatitis When Compared With the Ranson Score and Serum CRP Levels

“…The median hospital stay length was eight days in the present study. However, the duration of median length of hospital stays in other studies as carried out by Roberts S E et al, Gillick K et al, Park JY et al, and Khanna KA et al was similar to the present study [1,[11][12]15]. The present study's overall admission rate into an ICU setting was (7 out of 47 patients).…”

“…Therefore, the rate of mortality was 8.5%. Nearly identical results concerning mortality rate were observed in studies done by Khanna KA et al and Gillick K et al (12.5% and 8.0%, respectively) [1,12]. In the study by Halonen KI et al, hospital mortality in severe acute pancreatitis in a general intensive care unit was as high as 38.1% [14].…”

“…Acute pancreatitis (AP) is a common emergency room presentation, with a mortality rate of 30-50% [1]. The natural history of AP ranges from mild to severe forms.…”

Can Waterlow score predict 30-day mortality and length of stay in acutely admitted medical patients (aged ≥65 years)? Evidence from a single centre prospective cohort study

“…A positive correlation has been shown between surgical patients with WS above 15 and mortality 19. It also correlated with rates of postoperative infections in a study in patients with fractured neck of femur20 and in predicting outcomes in patients with acute pancreatitis, with an AUC score of 0.73 for mortality 21. Furthermore, it has specifically been found to be an independent predictor of mortality among acute medical patients suffering from dementia 22.…”