| Acute pancreatitis is a common and potentially lethal inflammatory process witha highly variable clinical course.Persistent organ failure develops in10%-20%ofpatients，with mortality reaching30%in this subgroup.The BISAP score represents asimple way to identify patients at risk of increased mortality within24h ofpresentation.The primary aim of this study was to evaluate the ability of BISAPscore to predict motality and persistent organ failure in patients with acutepancreatitis.This study make up three parts.(1) Comparison of the value of BISAP, Ranson’s,APACHE-Ⅱ Scores at admission in predicting Persistent Organ Failure, Mortality inAcute Pancreatitis.(2)Comparison of Dynamic BISAP, APACHE-Ⅱ Scores inpredicting Persistent Organ Failure, Mortality in Acute Pancreatitis.(3)Comparisonof BISAP，Ranson，s，APACHE-Ⅱ Scores in predicting Persistent Organ Failure，Mortality in Acute Pancreatitis at different treatment time. Part one Comparison of the value of BISAP, Ranson’s, APACHE-ⅡScores at admission in predicting Persistent Organ Failure, Mortalityin Acute PancreatitisObjiective To compare the value of BISAP,Ranson,s,APACHE-Ⅱ Scores atadmission in predicting persistent organ failure, mortality in acute pancreatitis.Methods Extensive demographic and laboratory data from consecutive patientswith acute pancreatitis (AP) admitted or transferred to the first affiliated hospital ofNanchang university from November2009to January2012. Organ failure includedshock (systolic blood pressure＜90mmHg),or renal failure (serum creatinine＞2mg/dL after rehydrationor hemodialysis), pulmonary insufficiency (PaO2＜60mmhgat room air or the need for mechanical ventilation), Persisten organ failure wasdefined as calculated when patients were admitted and48hours later.Dataassociating to Ranson,APACHE-Ⅱ,BISAP score systems after admission wererecorded.Predictive accuracy of the scoring systems was measured by the area underthe receiver operator curve(AUC).Results There were310patients with AP (mean age50.5,54.5%males).Thirty-two patients developed persistent organ failure (10.3%)and11died (mortality3.5%).AUCs for BISAP, Ranson,s, APACHE-Ⅱ in predicting persistent organ failureare0.68(95%Cl:0.59-0.78),0.76(95%Cl:0.70-0.86),0.83(95%Cl:0.75-0.91), respect-tively.AUCs for BISAP,Ranson,s,APACHE-Ⅱ in predicting mortality are0.72(95%Cl:0.59-0.84),0.84(95%Cl:0.75-0.94),0.83(95%Cl:0.70-0.97), respectively.Conclusions We confirmed that BISAP score is an accurate means for riskstratification in patients with AP. Its components are clinically relevant and easy toobtain.The prognostic accuracy of BISAP is similar to Ranson，s, APACHE-Ⅱ scoringsystems at admission in predicting persistent organ failure,mortality in acute pancreatitis. Part two Comparison of Dynamic BISAP, APACHE-Ⅱ Scores inpredicting Persistent Organ Failure, Mortality in Acute PancreatitisObjiective To compare the value of dynamic BISAP,APACHE-Ⅱ Scores inpredicting persistent organ failure, mortality in acute pancreatitis.Methods Extensive demographic and laboratory data from consecutive patientswith acute pancreatitis (AP) admitted or transferred to the first affiliated hospital ofNanchang university from November2009to January2012. Organ failure includedshock (systolic blood pressure＜90mmHg),or renal failure (serum creatinine＞2mg/dL after rehydrationor hemodialysis), pulmonary insufficiency (PO2＜60mmHgat room air or the need for mechanical ventilation).Persisten organ failure wasdefined as calculated when patients were admitted and48hours later.Data associatingto Ranson,APACHE-Ⅱ,BISAP score systems after admissions were recorded.Predictive accuracy of the scoring systems was measured by the area under thereceiver operator curve(AUC).And the use of48hours,72hours dynamic score topredicting persistent organ failure,mortality in acute Pancreatitis.Results （1）There were310patients with AP (mean age50.5,54.5%males).Thirty-two patients developed persistent organ failure and11died.AUCs for BISAPin predicting persistent organ failure are0.68(95%Cl:0.59-0.78),0.83（95%Cl:0.76-0.90）,0.86(95%Cl:0.80-0.93).AUCs for BISAP in predicting mortality are0.72(95%Cl:0.59-0.84),0.84(95%Cl:0.74-0.94),0.89(95%Cl:0.77-1.00),respectively.AUCs for APACHE-Ⅱ in predicting persistent organ failure are0.83(95%Cl:0.75-0.91),0.91(95%Cl:0.87-0.96),0.93(95%Cl:0.90-0.97),respectively. AUCs for APACHE-Ⅱin predicting mortality are0.83(95%Cl:0.70-0.97）,0.95(95%Cl:0.91-0.99),0.93(95%Cl:0.89-0.96), respectively.（2）Patients with a BISAP score increase by50%in48hour had a3-fold higherlikehood of death,5times for persistent organ failure. Patients with a BISAP scoreincrease by50%in72hour had a6-fold higher likehood of death,7times for persistent organ failure. Patients with a APACHE-Ⅱ score increase by20%in48hourhad a2-fold higher likehood of death,2times for persistent organ failure. Patientswith a APACHE-Ⅱ score increase by20%in72hour had a2-fold higher likehood ofdeath,2times for persistent organ failure.Conclusions We confirmed that the dynamic BISAP score and APACHE-Ⅱscore are reliable prognostic tools in predicting mortality in acute pancreatitis. Part three Comparison of BISAP，Ranson，s，APACHE-Ⅱ Scores inpredicting Persistent Organ Failure，Mortality in Acute Pancreatitisat different treatment timeObjiective To compare the value of BISAP, Ranson,s,APACHE-Ⅱ Scores inpredicting persistent organ failure,mortality in acute pancreatitis at different treatmenttime.Methods Extensive demographic and laboratory data from consecutivepatients with acute pancreatitis (AP) admitted or transferred to the first affiliatedhospital of Nanchang university from November2009to January2012. Renalinsufficiency (serum creatinin＞2mg/dL after rehydration),shock (＜90mm Hgsystolic blood pressure during at least15minutes),respiratory in sufficiency(PaO2≤60mmHg), Persisten organ failure was defined as calculated when patientswere admitted and48hours later.Data associated to Ranson,s APACHE-Ⅱ,BISAPscoring systems after admissions were recorded.Predictive accuracy of the scoringsystems was measured by the area under the recever operator curve(AUC).Results There were310patients with AP (mean age50.5,54.5%males).Thirty-two patients developed persistent organ failure and11died (mortality3.5%).Patients were divided into treatment from the time of onset≤7days group accordingto the patient treatment time, and＞7days groups.There were262patients (85%),48patients (15%),repectively. In the two groups，the number of patients developedpersistent organ failure was30cases(94%),2cases（6%）.AUCs for BISAP, Ranson,s, APACHE-Ⅱ in predicting persistent organ failure in≤7days group are0.71（95%CI：0.62-0.81）,0.77（95%CI：0.67-0.87）,0.84（95%CI：0.75-0.92）and AUCs for BISAP, Ranson,s, APACHE-Ⅱ persistentmortality are0.75（95%CI：0.62-0.88）,0.75（95%C:0.62-0.88）,0.83（95%CI：0.68-0.98）, respectively. AUCs for BISAP, Ranson,s, APACHE-Ⅱ in predicting persistent organ failure in＞7days group are0.46（95%CI：0.26-0.65）,0.73（95%CI：0.49-0.98）,0.73（95%CI：0.47-0.98） and AUCs for BISAP, Ranson,s,APACHE-Ⅱ in predicting mortality are0.48（95%CI：0.21-0.75）,0.46（95%CI：0.17-0.75）,0.37（95%CI：0.13-0.61）respectively.Conclusions1.BISAP, APACHE Ⅱ,Ranson,s are reliable prognostic tools inpredicting in treatment from the time of onset≤7days group.2.BISAP, APACHE Ⅱ,Ranson,s aren,t reliable prognostic tools in predicting intreatment from the time of onset＞7day group. |
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