Comparision Of Four Scoring Systems In Predicting The Severity Of Acute Pancreatitis According To The New Atlanta Classification

Objective:The purpose of this study is to investigate the diagnostic accuracy of the Acute Physiology and Chronic Health Examination II (APACHE II) score, Bedside Index of Severity in Acute Pancreatitis (BISAP) score, Ranson score and Balthazar CT grading score in differentiating the moderate severe acute pancreatitis (MSAP) and severe acute pancreatitis SAP.Methods:We retrospectively analyzed 131 consecutive patients with acute pancreatitis (AP) from the First Affiliated Hospital of Dalian Medical University between January 2010 and January 2015. We divided the patients into MSAP and SAP groups according to the general information of patients, causative factors, clinical manifestations, results of laboratory tests and imaging examination. The diagnostic accuracy of the Acute Physiology and Chronic Health Examination II (APACHE II) score, Bedside Index of Severity in Acute Pancreatitis (BISAP) score, Ranson score and Balthazar CT grading score in Predicting the SAP were assessed within the first 48 hours after hospitalization.Results:The median age of SAP group was 45 (36-60) years. The median age of MSAP group was 53.5 (39-65) years. Biliary derived pancreatitis in MSAP and SAP groups accounted for 61%,62.4%, repectively. The two groups showed no significant differences in etiological constitution, the past history, bad habits. Ascites, Grey-Tuner, Cullen and hypocalcemia (<1.87mmol/L) indicates severe acute pancreatitis. Serum creatinine, blood urea nitrogen and calcium between the two groups displayed no obvious differences (P<0.05). The respiratory system was the most vulnerable organ which accounted for 76.7% in MSAP group and 95% in SAP group. The disfunction of kidney in MSAP and SAP groups accounted for 23.3%,30%, respectively. The mortality was remarkably elevated when multiple organs disfunction failure (MODS) was happened. Receiver operating characteristic (ROC) analysis indicated that the area under curve (AUC) of APACHE II score, Balthalthar score, BISAP score, Ranson score in SAP group was 0.8598,0.8272,0.8060,0.7868, respectively. The power of APACHE II score in predicting SAP was higher than other scoring systems.Conclusions:The symptoms of ascites, Grey-Tuner, Cullen and hypocalcemia (<1.87mmol/L) was highly predicting SAP. Biliary tract disease is the main cause of SAP. there is no obvious relationship between different causes and severity of the disease. The main cause of death of SAP patients is MODS. Acute respiratory dysfunction and acute renal dysfunction were mostly involved. Prevention the occurence of MODS is a valid method to reduce the mortality of SAP. The APACHE II score has the high accuracy in evaluating the severity of the acute pancreatitis. We should take comprehensive consideration applying the scoring system to clinical practice.