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Journal of Chinese Integrative Medicine ›› 2009, Vol. 7 ›› Issue (1): 34-40.doi: 10.3736/jcim20090105

• Original Clinical Research • Previous Articles     Next Articles

Value of four scoring systems for predicting prognosis of severe acute pancreatitis

 Jing-yun Fana, Zong-wen Huangb, Jia Guob   

  1. a Department of Gastroenterology, Suining People's Hospital, Suining, Sichuan Province 629000, China
    b Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
  • Received:2008-08-18 Accepted:2008-10-15 Online:2009-01-20 Published:2009-01-15


To evaluate the value of Ranson, acute physiology and chronic health evaluationⅡ (APACHEⅡ), Balthazar CT and pancreatitis outcome prediction (POP) scoring systems in predicting the prognosis of severe acute pancreatitis (SAP).

A total of 253 consecutive patients with SAP, admitted into West China Hospital of Sichuan University from January 2004 to August 2007 were studied retrospectively. Data associated to Ranson, APACHEⅡ, Balthazar CT and POP scoring systems after admissions were recorded. Four outcome signals including death, local complications, operation transformation, and development of multiple organ dysfunction syndrome (MODS) were analyzed. The receiver operating characteristic (ROC) curves were also drawn and the areas under the ROC curve (AUC) were obtained to compare the sensitivity, specificity, Youden index, and likelihood ratio positive test (LRPT) of the clinical scoring systems in assessing the prognosis of SAP.

Through comparison of AUC, Ranson score could be used to predict the outcomes except for local complications (P=0.00), and all its diagnosis threshold was 5. APACHEⅡscore showed that it could assess the outcomes of SAP except for local complications (P=0.00). Its thresholds in mortality, operation transformation, and incidence of MODS were 14, 10, and 12 respectively. Balthazar CT could predict all the outcomes, and the threshold was 6. POP score could predict all the outcomes except for local complications, and its predictive value in mortality was particularly prominent. The sensitivity and specificity of POP in predicting death were 0.90 and 0.92 as the cutoff was no less than 14. The thresholds of POP in mortality, operation transformation, and incidence of MODS were 14, 8, and 10 respectively.

The prognostic ability of the four scoring systems is not the same. Ranson, APACHEⅡ and POP scoring systems can predict the severity of SAP and entire complication, but they can't predict the local complications. POP score may predict the mortality well, and Balthazar CT scanning can predict all the outcomes, but the sensitivity and specificity are low.

Key words: Acute necrotizing pancreatitis, Prognosis, Acute physiology and chronic health evaluation, Patient outcome assessment

Table 1

Prediction analysis of death by four scoring systems"

Scoring system AUC Standard
95% confidence
P Youden index Sensitivity Specificity Cutoff LRPT
Ranson 0.90 0.03 0.85-0.95 0.00 0.63 0.93 0.70 ≥5 3.13
APACHEⅡ 0.93 0.02 0.89-0.98 0.00 0.75 0.90 0.85 ≥14 5.81
Balthazar CT 0.74* 0.04 0.66-0.82 0.00 0.41 0.70 0.71 ≥6 2.45
POP 0.96 0.01 0.94-0.99 0.00 0.82 0.90 0.92 ≥14 11.25

Figure 1

ROC curves of four scoring systems in predicting death"

Table 2

Prediction analysis of local complications by four scoring systems"

Scoring system AUC Standard
95% confidence
P Youden index Sensitivity Specificity Cutoff LRPT
Ranson 0.57 0.04 0.49-0.65 0.10 0.14 0.89 0.26 ≥5 1.19
APACHEⅡ 0.57 0.04 0.50-0.64 0.11 0.21 0.75 0.45 ≥7 1.38
Balthazar CT 0.67* 0.04 0.60-0.74 0.00 0.23 0.53 0.70 ≥6 1.77
POP 0.53 0.04 0.44-0.61 0.56 0.16 0.53 0.64 ≥10 1.44

Figure 2

ROC curves of four scoring systems in predicting local complications"

Table 3

Prediction analysis of operation transformation by four scoring systems"

Scoring system AUC Standard
95% confidence
P Youden index Sensitivity Specificity Cutoff LRPT
Ranson 0.78 0.05 0.69-0.88 0.00 0.45 0.81 0.63 ≥5 2.22
APACHEⅡ 0.77 0.05 0.68-0.86 0.00 0.51 0.94 0.57 ≥10 2.18
Balthazar CT 0.89 0.04 0.81-0.97 0.00 0.63 0.94 0.69 ≥6 3.01
POP 0.78 0.05 0.70-0.87 0.00 0.47 1.00 0.47 ≥8 1.90

Figure 3

ROC curves of four scoring systems in predicting operation transformation"

Table 4

Prediction analysis of MODS by four scoring systems"

Scoring system AUC Standard
95% confidence
P Youden index Sensitivity Specificity Cutoff LRPT
Ranson 0.90 0.02 0.86-0.94 0.00 0.67 0.85 0.83 ≥5 4.91
APACHEⅡ 0.91 0.02 0.87-0.95 0.00 0.69 0.82 0.87 ≥12 6.32
Balthazar CT 0.74* 0.03 0.67-0.80 0.00 0.35 0.58 0.76 ≥6 2.46
POP 0.86 0.03 0.82-0.91 0.00 0.59 0.80 0.79 ≥10 3.86

Figure 4

ROC curves of four scoring systems in predicting MODS"

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