Predictive value of three scoring systems in patients with severe acute pancreatitis_West China Medical Journal

Authors：

ZUO Yanyan ^1,2 , LI Yunwei ³ ,  KANG Yan ¹

1. Department of Critical Care Medcine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Anesthesiology, the Fourth People’s Hospital of Langfang, Langfang, Hebei 065700, P. R. China;
3. Department of Emergency Medicine, the Fourth People’s Hospital of Langfang, Langfang, Hebei 065700, P. R. China;

Corresponding?author：

KANG Yan, Email: kang_yan_123@163.com

Keywords：

Severe acute pancreatitis; Acute Physiology and Chronic Health Evaluation Ⅱ score; Ranson score; Sequential Organ Failure Assessment score; Prognosis

DOI：

10.7507/1002-0179.201909211

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Objective To analyze the roles of three scoring systems, i.e. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Ranson’s criteria, and Sequential Organ Failure Assessment (SOFA), in predicting mortality in patients with severe acute pancreatitis (SAP) admitted to intensive care unit (ICU), and explore the independent risk factors for mortality in SAP patients.Methods The electronic medical records of SAP patients who admitted to ICU of West China Hospital, Sichuan University between July 2014 and July 2019 were retrospectively analyzed. Data of the first APACHE Ⅱ, Ranson’s criteria, SOFA score, duration of mechanical ventilation, the use of vasoactive drugs and renal replacement therapy, and outcomes were obtained. The receiver operator characteristic (ROC) curve was used to evaluate the value of APACHE Ⅱ score, Ranson’s criteria, and SOFA score in predicting the prognosis of SAP. Logistic regression models were created to analyze the independent effects of factors on mortality.Results A total of 290 SAP patients hospitalized in ICU were screened retrospectively, from whom 60 patients were excluded, and 230 patients including 162 males and 68 females aged (51.1±13.7) years were finally included. The ICU mortality of the 230 patients with SAP was 27.8% (64/230), with 166 patients in the survival group and 64 patients in the death group. The areas under ROC curves of APACHE Ⅱ, Ranson’s criteria, APACHE Ⅱ combined with Ranson’s criteria, and SOFA score in predicting mortality in SAP patients admitted to ICU were 0.769, 0.741, 0.802, and 0.625, respectively. The result showed that APACHE Ⅱcombined with Ranson’s criteria was superior to any single scoring system in predicting ICU death of SAP patients. The result of logistic regression analysis showed that APACHE Ⅱ score [odds ratio (OR)=1.841, 95% confidence interval (CI) (1.022, 2.651), P=0.002], Ranson’s criteria [OR=1.542, 95%CI (1.152, 2.053), P=0.004], glycemic lability index [OR=1.321, 95%CI (1.021, 1.862), P=0.008], the use of vasoactive drugs [OR=15.572, 95%CI (6.073, 39.899), P<0.001], and renal replacement therapy [OR=4.463, 95%CI (1.901, 10.512), P=0.001] contributed independently to the risk of mortality.Conclusions APACHE Ⅱ combined with Ranson’s criteria is better than SOFA score in the prediction of mortality in SAP patients admitted to ICU. APACHE Ⅱ score, Ranson’s criteria, glycemic lability index, the use of vasoactive drugs and renal replacement therapy contribute independently to the risk of ICU mortality in patients with SAP.

Citation： ZUO Yanyan, LI Yunwei, KANG Yan. Predictive value of three scoring systems in patients with severe acute pancreatitis. West China Medical Journal, 2019, 34(11): 1233-1238. doi: 10.7507/1002-0179.201909211 Copy

1.	中華醫學會消化病學分會胰腺疾病學組, 中華胰腺病雜志編輯委員會, 中華消化雜志編輯委員會. 中國急性胰腺炎診治指南 (2013 年, 上海). 中華消化雜志, 2013, 33(4): 217-222.
2.	Xu H, Ebner L, Jiang S, et al. Retrocrural space involvement on computed tomography as a predictor of mortality and disease severity in acute pancreatitis. PLoS One, 2014, 9(9): e107378.
3.	Bugiantella W, Rondelli F, Boni M, et al. Necrotizing pancreatitis: a review of the interventions. Int J Surg, 2016, 28(Suppl 1): S163-S171.
4.	雍鳳嬌, 夏慶. 急性胰腺炎分型系統及預測系統進展. 華西醫學, 2016, 31(1): 175-179.
5.	Ranson JH, Rifkind KM, Roses DF, et al. Objective early identification of severe acute pancreatitis. Am J Gastroenterol, 1974, 61(6): 443-451.
6.	Banks PA, Freeman ML, Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10): 2379-2400.
7.	UK Working Party on Acute Pancreatitis. UK guidelines for the management of acute pancreatitis. Gut, 2005, 54(Suppl 3): iii1-iii9.
8.	Yeung YP, Lam BY, Yip AW. APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis. Hepatobiliary Pancreat Dis Int, 2006, 5(2): 294-299.
9.	Li M, Xing XK, Lu ZH, et al. Comparison of scoring systems in predicting severity and prognosis of hypertriglyceridemia-induced acute pancreatitis. Dig Dis Sci, 2019.
10.	Adam F, Bor C, Uyar M, et al. Severe acute pancreatitis admitted to intensive care unit: SOFA is superior to Ranson’s criteria and APACHE II in determining prognosis. Turk J Gastroenterol, 2013, 24(5): 430-435.
11.	Khan AA, Parekh D, Cho Y, et al. Improved prediction of outcome in patients with severe acute pancreatitis by the APACHE II score at 48 hours after hospital admission compared with the APACHE II score at admission. Acute physiology and chronic health evaluation. Arch Surg, 2002, 137(10): 1136-1140.
12.	Tee YS, Fang HY, Kuo IM, et al. Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis. Medicine (Baltimore), 2018, 97(7): e9654.
13.	Escobar-Arellano R, Guraieb-Barragán E, Mansanares-Hernández A, et al. Sensitivity, specificity and reliability of the POP score vs. APACHE II score as predictors of severe acute biliary pancreatitis. Cir Cir, 2019, 87(4): 402-409.
14.	Harshit Kumar A, Singh Griwan M. 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. Gastroenterol Rep (Oxf), 2018, 6(2): 127-131.
15.	馮睿智, 呂建琴, 潘慧, 等. 重癥急性胰腺炎胰腺感染的危險因素研究進展. 華西醫學, 2014, 29(12): 2391-2393.

1. 中華醫學會消化病學分會胰腺疾病學組, 中華胰腺病雜志編輯委員會, 中華消化雜志編輯委員會. 中國急性胰腺炎診治指南 (2013 年, 上海). 中華消化雜志, 2013, 33(4): 217-222.
2. Xu H, Ebner L, Jiang S, et al. Retrocrural space involvement on computed tomography as a predictor of mortality and disease severity in acute pancreatitis. PLoS One, 2014, 9(9): e107378.
3. Bugiantella W, Rondelli F, Boni M, et al. Necrotizing pancreatitis: a review of the interventions. Int J Surg, 2016, 28(Suppl 1): S163-S171.
4. 雍鳳嬌, 夏慶. 急性胰腺炎分型系統及預測系統進展. 華西醫學, 2016, 31(1): 175-179.
5. Ranson JH, Rifkind KM, Roses DF, et al. Objective early identification of severe acute pancreatitis. Am J Gastroenterol, 1974, 61(6): 443-451.
6. Banks PA, Freeman ML, Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10): 2379-2400.
7. UK Working Party on Acute Pancreatitis. UK guidelines for the management of acute pancreatitis. Gut, 2005, 54(Suppl 3): iii1-iii9.
8. Yeung YP, Lam BY, Yip AW. APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis. Hepatobiliary Pancreat Dis Int, 2006, 5(2): 294-299.
9. Li M, Xing XK, Lu ZH, et al. Comparison of scoring systems in predicting severity and prognosis of hypertriglyceridemia-induced acute pancreatitis. Dig Dis Sci, 2019.
10. Adam F, Bor C, Uyar M, et al. Severe acute pancreatitis admitted to intensive care unit: SOFA is superior to Ranson’s criteria and APACHE II in determining prognosis. Turk J Gastroenterol, 2013, 24(5): 430-435.
11. Khan AA, Parekh D, Cho Y, et al. Improved prediction of outcome in patients with severe acute pancreatitis by the APACHE II score at 48 hours after hospital admission compared with the APACHE II score at admission. Acute physiology and chronic health evaluation. Arch Surg, 2002, 137(10): 1136-1140.
12. Tee YS, Fang HY, Kuo IM, et al. Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis. Medicine (Baltimore), 2018, 97(7): e9654.
13. Escobar-Arellano R, Guraieb-Barragán E, Mansanares-Hernández A, et al. Sensitivity, specificity and reliability of the POP score vs. APACHE II score as predictors of severe acute biliary pancreatitis. Cir Cir, 2019, 87(4): 402-409.
14. Harshit Kumar A, Singh Griwan M. 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. Gastroenterol Rep (Oxf), 2018, 6(2): 127-131.
15. 馮睿智, 呂建琴, 潘慧, 等. 重癥急性胰腺炎胰腺感染的危險因素研究進展. 華西醫學, 2014, 29(12): 2391-2393.

West China Medical Journal

Predictive value of three scoring systems in patients with severe acute pancreatitis

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