Abstract
Introduction: A number of scoring systems have been developed to predict the prognosis of acute pancreatitis (AP). Extra pancreatic inflammation as evident by pleural effusion, ascites, and retroperitoneal fluid collections has been shown to be an important marker of severity. Aim: To compare EPIC scoring system with BISAP, SIRS, CTSI and MCTSI and Renal rim grade scoring systems in predicting persistent organ failure (POF), intervention and mortality in AP. Patients and Methods: The demographic, radiographic, and laboratory data from consecutive patients with AP admitted in our unit over last 14 months were retrospectively evaluated. The SIRS, BISAP, CTSI, MCTSI, Renal rim grade and the EPIC score (based on the presence of pleural effusion, ascites, and retroperitoneal and mesenteric inflammation) were calculated for all the patients. The scores were evaluated by calculating receiver operator characteristic (ROC) curves and the area under the ROC curve. Results: One hundred and five patients (65 males; mean age 40.6± 12.9 years) with AP were included in the study. Eight patients died and 71 patients developed POF whereas radiological/ endoscopic intervention were needed in 16 patients. The mean CTSI, MCTSI and EPIC score were 5.8 ± 3.0, 7.1 ± 2.6 and 4.0 ± 1.9 respectively. The area under curves (AUC) for SIRS, BISAP, CTSI, MCTSI, Renal Rim Score and EPIC score in predicting POF were 0.65 (CI: 0.53-0.78), 0.75 (CI: 0.65-0.86), 0.66 (CI: 0.54-0.78), 0.70 (CI: 0.58-0.81), 0.64 (0.52-0.76), 0.71 (CI: 0.60-0.83) respectively, for radiological/endoscopic intervention were 0.50 (CI: 0.35-0.65), 0.64 (CI: 0.49-0.78), 0.51 (CI: 0.36-0.66), 0.55 (CI: 0.41-0.70),0 .51 (0.36-0.67), 0.66 (CI: 0.52-0.81) respectively, and for mortality 0.57 (CI: 0.38-0.75), 0.90 (CI: 0.83-0.97), 0.67 (CI: 0.50-0.83), 0.68 (CI: 0.51-0.85), 0.73 (CI: 0.57-0.89) and 0.77 (CI: 0.64-0.90) respectively. Conclusion: The predictive assessment of radiological scoring systems for POF, need for intervention and mortality is similar to clinical scoring systems. EPIC score is superior to other radiological scoring systems in predicting endoscopic/radiological intervention.
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