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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

Objective

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).
Methods

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.
Results

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.
Conclusion

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
difference
95% confidence
interval
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
difference
95% confidence
interval
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
difference
95% confidence
interval
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
difference
95% confidence
interval
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"

[1] Group of Pancreatopathy, Branch Association for Diseases of Digestive System, Chinese Medical Association. Draft criteria for diagnosis and treatment of acute pancreatitis in China[J]. Zhonghua Nei Ke Za Zhi, 2004,43(3):236-238
中华医学会消化病学分会胰腺疾病学组. 中国急性胰腺炎诊治指南(草案)[J]. 中华内科杂志, 2004,43(3):236-238
[2] Whitcomb DC . Acute pancreatitis[J]. N Engl J Med, 2006,354(20):2142-2150
doi: 10.1056/NEJMcp054958
[3] Mortele KJ, Wiesner W, Intriere L, Shankar S, Zou KH, Kalantari BN, Perez A, Sonnenberg EV, Ros PR, Banks PA, Silverman SG . A modified severity index for evaluating acute pancreatitis: improved correlation with patients' outcome[J]. AJR, 2004,183(5):1261-1265
doi: 10.2214/ajr.183.5.1831261
[4] Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC . Prognostic signs and role of operative management in acute pancreatitis[J]. Surg Gynecol Obstet, 1974,139(1):69-81
[5] Ranson JH . The timing of biliary surgery in acute pancreatitis[J]. Ann Surg, 1979,189(5):654-663
doi: 10.1097/00000658-197905000-00016
[6] Knaus WA, Draper EA, Wagner DP, Zimmerman JE . APACHEⅡ: a severity of disease classification system[J]. Crit Care Med, 1985,13(10):818-829
doi: 10.1097/00003246-198510000-00009
[7] Balthazar EJ, Freeny PC, van Sonnenberg E .Imaging and intervention in acute pancreatitis[J]. Radiology, 1994,193(2):297-306
doi: 10.1148/radiology.193.2.7972730
[8] Harrison DA, D'Amico G, Singer M .The Pancreatitis Outcome Prediction(POP) Score: a new prognostic index for patients with severe acute pancreatitis[J]. Crit Care Med, 2007,35(7):1703-1708
doi: 10.1097/01.CCM.0000269031.13283.C8
[9] Hanley JA, McNeil BJ .The meaning and use of the area under a receiver operating characteristic(ROC) curve[J]. Radiology, 1982,143(1):29-36
doi: 10.1148/radiology.143.1.7063747
[10] Modrau S, Floyd AK, Thorlacius-Ussing O . The clinical value of procalcitonin in early assessment of acute pancreatitis[J]. Am J Gastroenterol, 2005,100(7):1593-1597
doi: 10.1111/ajg.2005.100.issue-7
[11] Gong ZH, Wang XP . Prognosis and treatment of acute pancreatitis evaluated by evidence-based medicine[J]. Yi Xian Bing Xue, 2002,2(2):116-119
龚自华, 王兴鹏 . 用循证医学的原理评价急性胰腺炎的预后和治疗[J]. 胰腺病学, 2002,2(2):116-119
[12] Wang ZQ, Li JS . The progress of CT evaluation in acute pancreatitis[J]. Yi Xue Yan Jiu Sheng Xue Bao, 2002,15(5):450-452
王中秋, 黎介寿 . 急性胰腺炎CT评价及进展[J]. 医学研究生学报, 2002,15(5):450-452
[13] Le XH, Xie HZ . Evaluation of scoring systems in acute pancreatitis[J]. Xian Dai Xiao Hua Ji Jie Ru Zhen Liao, 2007,12(3):195-199
乐星华, 谢会忠 . 急性胰腺炎评分标准的评价[J]. 现代消化及介入诊疗, 2007,12(3):195-199
[14] Knoepfli AS, Kinkel K, Berney T, Morel P, Becker CD, Poletti PA . Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?[J]. Abdom Imaging, 2007,32(1):111-115
doi: 10.1007/s00261-006-9034-y
[15] Miskovitz P . A new prognostic system for severe acute pancreatitis[J]. Crit Care Med, 2007,35(7):1787-1788
doi: 10.1097/01.CCM.0000269369.43690.60
[16] Chatzicostas C, Roussomoustakaki M, Vlachonikolis IG, Notas G, Mouzas Ⅰ, Samonakis D, Kouroumalis EA . Comparison of Ranson, APACHE Ⅱ and APACHE Ⅲ scoring systems in acute pancreatitis[J]. Pancreas, 2002,25(4):331-335
doi: 10.1097/00006676-200211000-00002
[17] Wang YQ, Zhou MQ, Zhao J, Shen CL . Value of APACHE Ⅱ, Ranson and Balthazar scoring system predicting the severity and prognosis and indicating therapy for severe acute pancreatitis[J]. Lin Chuang Wai Ke Za Zhi, 2007,15(2):109-111
王约青, 周鸣清, 赵坚, 沈承澜 .APACHEⅡ, Ranson, Balthazar评估系统对重症急性胰腺炎诊断及预后评估的参考价值[J]. 临床外科杂志, 2007,15(2):109-111
[18] Liu Y, Lu Z, Li ZS, Dong YH, Zhang WJ, Pan X . Prediction of outcome in acute pancreatitis: a comparative study of APACHE Ⅱ, Ranson and Balthazar computed tomography scoring systems[J]. Yi Xian Bing Xue, 2006,6(4):196-200
刘岩, 路筝, 李兆申, 董元航, 张文俊, 潘雪 . APACHEⅡ, Ranson和CT评分系统对重症急性胰腺炎预后评价的比较[J]. 胰腺病学, 2006,6(4):196-200
[19] Chen ZZ, Wang Z, Tan Y, Zhang Y, Ying SP, Yang ZH, Zhou C . Muti-detectorspiral CT scoring system to evaluate the severity of acute pancreatitis — the association of Balthazar and APACHE Ⅱ[J]. Zhonghua Ji Zhen Yi Xue Za Zhi, 2003,12(7):492-494
陈再智, 王志, 谭晔, 张燕, 应申鹏, 杨正汉, 周诚 . 急性胰腺炎严重度的多层螺旋CT评价——Balthazar CT 评分与APACHEⅡ评分的相关性[J]. 中华急诊医学杂志, 2003,12(7):492-494
[20] Zou XP, Gu C, Liu MD, Li YH, Qian C . A comparative study on three clinical criteria in predicting outcome of patients with acute pancreatitis[J]. Zhonghua Xiao Hua Za Zhi, 2007,27(1):32-35
邹晓平, 顾超, 刘明东, 李运红, 钱铖 . 三种临床评分标准对急性胰腺炎预后的评估价值比较[J]. 中华消化杂志, 2007,27(1):32-35
[21] Toosie A, Chang L, Renslo R, Arnell T, Bongard F, Stabile BE, De Virgilio C . Early computed tomography is rarely necessary in gallstone pancreatitis[J]. Am Surg, 1997,63(10):904-907
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