Balthazar Ct Severity Index versus Apache 2 Score in Predicting the Severity of Acute Pancreatitis

Abstract

Background: Acute pancreatitis has a variable clinical presentation. Due to the potential of catastrophic deterioration, early assessment of severity is essential. Various clinical scoring systems are available to assess severity of pancreatitis. Extent of pancreatic necrosis has been correlated with fatal outcome in the past few years 3, 4, . There is a need to evaluate the efficacy of clinical scoring system versus CT severity index to triage the patient into intensive care. Objective: To compare the efficacy of Balthazar CT severity index versus APACHE 2 score in predicting the severity of acute pancreatitis. Material and methods: A retrospective, cross sectional, analytical study was done on 30 patients over past 2 years. Clinical features, laboratory investigations, CT abdomen reports including the Balthazar CT severity index were obtained from the medical records department. Patients were categorised into mild, moderate and severe acute pancreatitis based on revised Atlanta classification. APACHE 2 scores were compared with CT severity indices. The data was analysed by AVOVA and ROC. Results: Patients were categorised into mild moderate and severe acute pancreatitis. 60% of the patients had moderate acute pancreatitis according. Mild and severe cases accounted for 16% and 23% respectively. Analysis of variance with Kruskalwallis test, with 95% confidence limits was highly significant (p=0.00). Multiple Comparisons with Mannwihtney test correlated significantly with severe pancreatitis (p= 0.00). On analysing APACHE 2 scores with the Revised Atlanta severity classification, it correlated significantly on Kruskalwallis between 95% confidence limits (p= 0.018). However multiple comparisons with Mannwihtney test correlated significantly with severe pancreatitis (p= 0.01) but failed to correlate with mild pancreatitis. ROC curves were used to analyse modality of choice for each category of acute pancreatitis. Area under the curve was used to determine cut off points of significance along with sensitivity and specificity. CT severity index was a better modality for mild and moderate and APACHE 2 was a better modality for severe pancreatitis. Conclusions: CT severity index is a better predictor of severity of acute pancreatitis. APACHE 2 score correlates better with severe acute pancreatitis.