Role of scoring systems in acute pancreatitis

Abstract

Background: Identification of patients at risk for severe disease early in the course of acute pancreatitis is an important step to formulating the management strategies for improving outcomes. Scoring systems designed for such assessment need critical evaluation regarding which and when to apply. Aims: To assess the efficacy of specific scoring systems like Ranson's score, Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring, Acute Physiology Score and the Chronic Health Evaluation II (APACHE II), and Modified Computed Tomography Severity Index (MCTSI) to predict severity, organ failure, and complications leading to mortality in acute pancreatitis. Materials and Methods: Ranson's, APACHE II and BISAP scores were calculated within 24 h of admission. Ranson's score was evaluated also after 48 h of admission. CT scan was performed after a period of 48 h only if the clinical course was unpredictable, morphological changes were detected on ultrasound abdomen or on clinical suspicion. MCTSI was evaluated in such cases. Results: There were 48 patients with acute pancreatitis (89.6% male) of which 11 patients underwent contrast-enhanced CT scan. Six patients developed organ failure and were classified as severe acute pancreatitis. Three patients had died. Six patients had a BISAP score >3, 5 patients with Ranson's score >3, 3 patients with APACHE II >8 and MCTSI >2 was seen in 9 patients. Area under curve for BISAP, Ranson's, APACHE II, and MCTSI in predicting severity are 0.79 (confidence interval [CI]: 0.605-0.967), 0.79 (CI: 0.524-1), 0.94 (CI: 0-1), and 0.61 (CI: 0.286-0.936), respectively. Conclusion: We recommend that although APACHE II score is a better predictor of organ failure, BISAPS should be used for the identification of high-risk patients because of its simplicity. Ranson's score still holds its place in identifying patients at risk of developing severe acute pancreatitis and organ failure. MCTSI though did not perform well, but still helps to identify local and systemic complications without pancreatic necrosis. It also defines scope and extent of the surgical intervention.