Thaddaeus J.K. Tan1, Wang Bei2, Winston W.L. Woon2, Jee Keem Low2, Terence Huey2, Sameer P Junnarkar2, Vishalkumar G Shelat2. 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 2Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
INTRODUCTION: Scoring systems (SS) are an essential pillar of care in acute pancreatitis (AP) management. We compared six SS (Acute Physiology and Chronic Health Examination (APACHE-II), Bedside Index for Severity in AP (BISAP), Glasgow score, Harmless AP score (HAPS), Ranson’s score and Sequential Organ Failure Assessment (SOFA) score) for their utility in predicting severity, intensive care unit (ICU) admission and mortality.
METHODS: AP patients treated between July 2009 and September 2016 were studied retrospectively. Demographic profile, clinical presentation and discharge outcomes were recorded. Predictive accuracy of six SS was assessed using areas under receiver-operative curve (AUC) with pairwise comparisons.
RESULTS: 675 patients were treated for AP. Twenty-two (3.3%) patients were excluded for insufficient data. 383/653(58.7%) were male and mean age was 58.7(20-98) years. Most common aetiology was gallstones (61.9%). Mean length of stay was 6.8(2-92) days. 81(12.4%) patients had severe AP, 20(3.1%) required ICU admission and 12(1.8%) died. Table below shows positive predictive value (PPV), negative predictive value (NPV) and AUC of six SS in predicting outcomes.
| Severity | ICU Admission | Mortality | |||||||
|---|---|---|---|---|---|---|---|---|---|
| PPV(%) | NPV(%) | AUC | PPV(%) | NPV(%) | AUC | PPV(%) | NPV(%) | AUC | |
| APACHE-II | 23.6 | 95.8 | 0.782 | 6.6 | 100.0 | 0.809 | 3.6 | 100.0 | 0.779 |
| BISAP | 42.6 | 89.9 | 0.717 | 10.6 | 97.5 | 0.690 | 6.4 | 98.5 | 0.647 |
| Glasgow | 25.6 | 95.4 | 0.781 | 7.0 | 99.3 | 0.818 | 4.1 | 99.5 | 0.809 |
| HAPS | 18.2 | 94.4 | 0.681 | 5.1 | 99.3 | 0.737 | 2.8 | 99.3 | 0.711 |
| Ranson | 21.4 | 98.0 | 0.848 | 5.7 | 100.0 | 0.946 | 3.4 | 100.0 | 0.917 |
| SOFA | 84.6 | 89.1 | 0.966 | 61.5 | 98.1 | 0.943 | 46.2 | 99.1 | 0.968 |
Pairwise comparisons revealed Ranson’s (p<0.016) and SOFA (p<0.024) scores were superior than other SS in predicting all three outcomes. AUC of SOFA was greater than Ranson’s score in predicting severity (p<0.001), but similar in predicting ICU admission (p=0.933) and mortality (p=0.150).
CONCLUSION: SOFA score is superior to classical SS in predicting severity, ICU admission, and mortality in AP.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87247
Program Number: P535
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster