A Comparison of Ransonʼs Criteria Versus Sequential Organ Failure Assessment Score (SOFA) in Predicting Intensive Care Unit Admission, Morbidity and Mortality in Acute Pancreatitis in the Emergency Room

Abstract

Purpose: To evaluate the outcome of patients admitted with acute pancreatitis and a comparison of Ranson's score with maximum Sequential Organ Failure Assessment (SOFA) score to predict the prognosis in the emergency room. Methods: Data from consecutive patients admitted with acute pancreatitis in a referral center in the year 2001–2006 were retrospectively collected. All charts were reviewed for Ranson's score at admission and 48 hrs and SOFA score daily for the first 5 days. The total maximum SOFA score was calculated summing the highest scores for all six systems. Organ dysfunction was considered as SOFA score of 1 or 2 points and organ failure as a SOFA score of 3 or more. The primary outcomes were mortality, admission to the intensive care unit and duration of hospital stay. Patients with < 18 years of age, known diagnosis of chronic pancreatitis or serum amylase and lipase < 3 times normal were excluded. Results: 167 patients were admitted to the hospital with a diagnosis of acute pancreatitis over the 2 year period (90 male, 77 female; median age 52 years, range 18–96 years). The etiology of pancreatitis was alcohol (42, 25%), gall stone (68,40%), post-ERCP (9, 5%) or other (48, 30%). The Ranson's score at admission was 1.26 ± 1.07. The maximum SOFA score at admission was 1.64 ± 1.76. 32 (19%) patients needed admission to the ICU. 7 patients died from complications of acute pancreatitis. The median hospital stay for all patients was 7 days (2–50 days). There was no association between Ranson score on admission and mortality. However, patients with a SOFA score ≥ 3 were 5.9 times more likely to die. (95% CI: 1.1 – 31.4), than those with a score < 3. 52.6% of those with Ranson ≥3 are admitted to the ICU during their hospitalization, whereas 16.3% of those with Ranson < 3 are admitted to the ICU, P < 0.001. 40.4% of those with SOFA ≥3 are admitted to the ICU during their hospitalization, whereas 10.9% of those with SOFA < 3 are admitted to the ICU, P < 0.0001. An elevated Ranson Score (P < .02) or SOFA score (P < .001) on admission was predictive of a length of stay greater than 7 days. Conclusion: On admission, both Ranson's score and SOFA score are useful in predicting the duration of hospital stay. The SOFA score was better in predicting the overall mortality.