Introduction: The need for assessing the severity of acute pancreatitis is because the management and prognosis are mainly decided by the severity of the disease. A parameter with high positive predictive value and accuracy which could be best correlated with clinical course, severity and identifies the local extent and complications, is beneficial for proper planning and management of the patient.
Materials and Methods: This was a prospective study conducted over 2 years period on admitted cases of acute pancreatitis. Total 157 patients were selected for study. All data regarding APACHE II Score, CT severity index and C - reactive protein parameter for assessing the prognosis of acute pancreatitis were analysed to find out best indicator.
Results: According to APACHE II scoring system 73.2% categorised as mild whereas 26.8% into severe groups. As per CT severity index, 79% patients were categorised in mild and 21 % in severe group. CRP level showed 61.7% in mild group whereas 38.3% in severe group. In our study CT Severity index showed highest sensitivity (84.2%), specificity (97.4%), positive predictive value (91.4%) negative predictive value (95%) and accuracy (94.2%), compared to APACHE II score and CRP levels.
Conclusion: The comparative study between different scoring systems, CTSI had the highest PPV, NPV, sensitivity, specificity and accuracy and best correlated with the clinical course of the disease and was able to detect the extent of local inflammation and the occurrence of local complications.
Keywords: Acute Pancreatitis, Atlanta classification, APACHE II score, CT Severity Index, C - reactive protein.
References
1. Acute Pancreatitis Classification Working Group. Revision of the Atlanta classification of acute pancreatitis, H: /MGSarr/Documents/ Atlanta Classification. doc.April 9, 2008.
2. Eachempati SR, Hydo LJ, Barie PS.Severity scoring for prognostication in patients with severe acute pancreatitis. Arch Surg 2002; 137:730-736.
3. Triester SL, Kowdley KV. Prognostic factors in acute pancreatitis. J Clin Gastroenterol 2002; 34:167-76.
4. Ranson JH, Rifkind KM, Roses DF, et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974;139(1):69-81
5. Yeng YP, Lam BY, Yip AW. Comparison between Ranson, APACHE II and APACHE-O. Hepatobiliary pancreas Dis. Int. May 2006; 5(2):294-9.
6. Bradley III EL. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, GA, September 11 through 13, 1992.Arch With.1993;128(5):586-90.
7. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology 1990; 174:331-336.
8. Balthazar EJ, Ranson JH, Naidich DP, et al. Acute pancreatitis: prognostic value of CT. Radiology1985; 156 ; ( 3); 767-72.
9. Dario J., Patrica C., Valderas G., et al. Prognostic value of CT in the early assessment of patients with acute pancreatitis. American Journal of Roentgenology. 2004; 182:569-574.
10. Knaus WA, Draper EA, Wager DP, Zimmerman JE. APACHE II; a severity of disease classification. Crit Care Med, 1985; 13:818-82.
11. Johnson CD, Toh SK, Campbell MJ, Combination of APACHE II and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis. Pancreatology, 2004; 4:1-6.
12. Yeung Y, Lam B, Yip A. APACHE system is better than Ranson criteria in the prediction of severity of acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2009; 5(2):294-9.
13. Viedma JA, Perez-Mateo M, Dominguez JE, Carballo F. Role of interleukin-6 in acute pancreatitis. Comparison with C - reactive protein and Phospholipase A. Gut 1992; 33; 1264-7.
14. Wilson C Heads A, Shenkin A, Imrie CW. C- Reactive Protein, anti-proteases and complement factors as objective markers of severity in acute pancreatitis. Br J Surg. 1989; 76; 177-181.
15. Clavien PA, Burgan S, Moossa AR. Serum enzymes and other laboratory tests in acute pancreatitis. Br J Surg 1989a; 76:1234-1243.
16. Jha PK, Chandran R, Jaiswal P, Seema K. A clinical study of risk factors of acute pancreatitis in a tertiary care centre in North India. Int Surg J 2017; 4:1878-83. DOI:doi.org/10.18203/2349-2902.isj20172053
17. Larvin M, McMahon MJ.APACHE II score for assessment and monitoring of acute pancreatitis. Lancet 1089; 2:201-5.
18. Osvaldt AB, Viero P, Borges MS, Wendt LR, Bersch VP, Rohde L, Evaluation of Ranson, Glasgow, APACHE II and APACHE -O criteria o predict severity in acute biliary pancreatitis. Int Surg. 2001; 86:158-61.
19. Robert JH, Frossard JL, Mermillod B, Soravia C, Mensi N, Roth M et al. Early prediction of acute pancreatitis: prospective study comparing computed tomography scans, Ranson , Glasgow, acute physiology and chronic health Evaluation II scores and various serum markers. World J Surg 2002:26:612-9.
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.76
