Clinical Practice Of Scoring Systems In Acute Pancreatitis.

Obiective In severe acute pancreatitis(SAP),it is important clinically to precdict the prognosis at the time of admission. Most scoring system for severity of acute pancreatitis consist of multiple factors and are complicated. This investigation aimed to compare with conventional scoring systems, and propose simple factors for the prediction of the prognosis of SAP.Methods Prognosis factors were evaluated by receiver operator characteristic curve analyses and multivariate analysis from data that were obtained on admission of 137 patients with SAP. There of the most useful factors was made for prognosis,and a combination of serum blood urea nitrogen,serum lactate dehydrogenase and contrast-enhanced computed tomography of usefulness was investigated in comparison with convevtional scoring systems. Results Three prognostic factors were selected:serum blood urea nitrogen≥8.9mmol/L,serum lactate dehydrogenase≥900U/L, and contrast-enhanced computed tomography finding with pancreatic necrosis, and one of these is defined a positive item,respectively.On admission,137 patients were classified from 0 to 3 by the number of postive items.Mortality rate for patients whose the number of postive items was 0,1,2and 3 were 2.3%(1/40 patients), 17.5%(7/40patients), 48%(12/25patients) and66.7%(20/30patients), respectively. Furthermore, when a combination of serum blood urea nitrogen, serum lactate dehydrogenase and contrast-enhanced computed tomography of usefulness was compared with conventional scoring systems, the area under the curve by receiver operator characteristic curve analyses in the former was 0.83; the Ranson score was 0.83; the Japanese severity score was 0.83; the Acute Physiology and Chronic Health valuation II score was 0.81, and the Glasgow score was 0.75. After onset, the number of positive items of the combination of serum blood urea nitrogen, serum lactate dehydrogenase and contrast-enhanced computed tomography of kept almost same levels from day 2 to day 6, and a significant difference was observed between survivors and onsurvivors from day 1 to day 6. Conclusion This combination that comprised 3 items is simple, is feasible for the prediction of prognosis and conventional scoring method, and is useful for the selection of the extremely severe patients with SAP early.