Sequential Organ Failure Assessment (SOFA) Score Is Superior to Classical Prognostic Indices in Prediction of Severity, Intensive Care Unit Admissions and Mortality in Acute Pancreatitis

Abstract

Introduction: Acute Pancreatitis (AP) is common and severe AP is potentially lethal. Many prognostic indices (APACHE-II, BISAP, Glasgow's, HAPS, Ranson's, SOFA) are used to predict severity. We evaluate utility of these indices in predicting severity, need for ICU admission, and mortality. Methodology: A retrospective audit of 653 patients with AP from July 2009 to September 2016 is done. The demographic and clinical profile and patient outcomes were collected. Severe acute pancreatitis (SAP) was defined as per revised Atlanta classification. Results: The mean age was 58.7±17.5 years with 58.7% males. Commonly identified etiologies of AP was gallstones(n=404, 61.9%), alcohol(n=38, 5.8%) and hypertriglyceridemia(n=19, 2.9%). 81(12.4%) patients developed SAP, 20(3.1%) required ICU admission and 12(1.8%) deaths were attributed to SAP. All-cause in-hospital mortality was 36(5.5%); 7(1.1%) cardiovascular causes, and 5(0.8%) pneumonia. Ranson's and APACHE-II demonstrated highest sensitivity in predicting SAP(92.6%, 80.2% respectively), ICU admission(100%) and mortality(100%). While SOFA and BISAP demonstrated lowest sensitivity in predicting SAP(13.6%, 24.7% respectively), ICU admission(40.0%, 25.0% respectively) and mortality(50.0%, 25.5% respectively). SOFA demonstrated highest specificity in predicting SAP(99.7%), ICU admission(99.2%) and mortality(98.9%). SOFA demonstrated highest positive predictive value, positive likelihood ratio, diagnostic odds ratio and overall accuracy in predicting SAP, ICU admission and mortality. The highest Area under Receiver-operator Curves(AUROC) was demonstrated by SOFA and Ranson's cumulative(Ranson score at 48 hours) in predicting SAP(0.966, 0.857 respectively), ICU admission(0.943, 0.946 respectively) and mortality(0.968, 0.917 respectively). Conclusion: SOFA score and Ranson's cumulative are accurate in severity stratification, prediction of ICU admission and mortality in acute pancreatitis.