Comparison of BISAP and Ranson’s score for predicting severe acute pancreatitis and establish the validity of BISAP score

Background: Pancreatitis can lead to serious complications with severe morbidity and mortality. So an early, quick and accurate scoring system is necessary to stratify the patients according to their severity so as to enable early initiation of required management and care. Scoring system commonly used have some drawbacks. This study aimed to compare bedside index for severity in acute pancreatitis (BISAP) and Ranson’s score to predict severe acute pancreatitis and establish the validity of a simple and accurate clinical scoring system for stratifying patients.Methods: This is a prospective comparative study on 100 patients diagnosed with acute pancreatitis admitted in department of general surgery. Parameters included in the BISAP and Ranson’s criteria were studied at the time of admission and after 48 hours. Result of these two were compared with that of revised Atlanta classification.Results: As per the BISAP score, the sensitivity and specificity were 95.8 % (95% CI, 76.8-99.8), 94.7 % (95% CI, 86.3-98.3) whereas positive likelihood ratio, negative likelihood ratio 18.21 (95% CI, 6.9-47.44), 0.04 (95% CI, 0.01-0.30) and accuracy was 95 % (95% CI, 88.72%-98.36%). On using Ranson’s score, the sensitivity and specificity were 91.6 (95% CI, 71.5-98.5) and 89.4 (95% CI, 79.8-95) with a positive predictive value 8.71 (95% CI, 4.47-18.96) and negative predictive value of 0.09 (95% CI, 0.02-0.35) and accuracy of 90% (95% CI, 82.38%-95.10%)..Conclusions: BISAP score outperformed Ranson’s score in terms of Sensitivity and specificity of prediction of severe pancreatitis. The authors recommend inclusion of BISAP Scoring system in standard treatment protocol of management of acute pancreatitis.

Estimation of Blood Urea Nitrogen as an Indicator of Severity in Acute Pancreatitis

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas with variable involvement of the pancreas, regional tissues around the pancreas, or remote organ systems. The aim of study was to evaluate Blood urea nitrogen (BUN) as an indicator of severity and single prognostic indicator in acute pancreatitis and to Compare BUN with Ranson’s and BISAP criteria in prediction of SAP and mortality. Methods: A prospective observational study, total 72 patients participated in this study. All Patients presenting to the Emergency and Outpatient Departments of Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar from October 2015 to September 2016 with suspicion of acute pancreatitis. Results: In the study, of these 66 (91.7%) were male and 6 (8.3%) were female. Mean age of the study subjects was 38.47 + 11.01. Mean age of patients with SAP was slightly higher than with non severe pancreatitis (41.89 vs. 37.33) but not statistically significant (p=0.55). 75% of the Pancreatitis was due to alcohol (54 out of 72), followed by gallstones in 13.88% (10/72). Conclusion: BISAP score within the first 24 hours of admission stratifies patients according to their risk of mortality and onset of organ failure.

Utility of surgical APGAR score in predicting post-operative morbidity and mortality in patients undergoing laparotomy – A prospective study

Background: The best model to determine the postoperative complications must be simple and easily applicable to the majority of surgical patients. The complications and their incidence should be precisely defined and estimated. The model should also have a low threshold to identify them. The ASA classification was initially intended as a means to stratify a patient’s systemic illness but not post-operative risk. Although the ASA classification has proved to be a predictive pre-operative risk factor in mortality models, its subjective nature and inconsistent scoring between providers make it less than ideal for performing evidence-based post-operative risk calculation. Aim of the study: The aim of the study was to determine the applicability of the Surgical Apgar Score in post-operative risk stratification for morbidity and mortality during the 30 days postlaparotomy. Materials and methods: In this study, 152 in-patient Visiting Government Stanley Medical College General Hospital from March 2017 to April 2018 had been studied. Patients undergone laparotomy at Department of General Surgery, Government Stanley Medical College were managed by a tier of doctors from anesthetic technicians, medical officer interns, medical officers, postgraduates in general surgery and anesthesiology and their consultants. Interns and postgraduates in general surgery provided the pre and postoperative care and participate in general surgical procedures whenever indicated. Anesthesiologists apart from providing anesthesia during surgery extended their care in the intensive care unit. Parimala, G. Venkatesh, P. Vijayaraghavan. Utility of surgical APGAR score in predicting post-operative morbidity and mortality in patients undergoing laparotomy – A prospective study. IAIM, 2019; 6(6): 67-74. Page 68 Results: 132 patients were operated as an emergency and only 20 patients were operated selectively. 86.8% of the surgeries were emergency laparotomies and only 13.2% of the surgeries were elective. This showed our efficient functioning and round the clock services of our emergency theatres. The most common causes in descending order include penetrating injury, intestinal obstruction, peritonitis, perforated duodenal ulcer, blunt injury abdomen, intra-abdominal abscess, hydatid cyst, obstructed hernia, mesenteric ischemia, cholecystitis. A significantly higher complication was noted among female patients at 63.2% compared to male patients at 33.3%. 43.9% of the postoperative complications occurred in emergency setting whereas only 20% of the complications occurred in the elective setting. When the complications were compared with the duration of surgery, those surgeries that lasted more than 120 minutes had a higher complication rate of 68.6% whereas surgeries with a shorter duration only had a complication rate of 26.7%. Conclusion: Surgical Apgar Score is very effective in identifying high-risk patients who are capable of developing significant complications following laparotomy within the first 30 postoperative days. This identification of high-risk patients helps us in the judicious use of healthcare resources towards the proper monitoring and follow up of these patients.

A comparative study between APACHE II and Ranson scoring systems in predicting the severity of acute pancreatitis

Background: Acute pancreatitis is a common disease with wide clinical variation and its incidence is increasing. Acute pancreatitis may vary in severity, from mild self-limiting pancreatic inflammation to pancreatic necrosis with life-threatening sequelae. The severity of acute pancreatitis is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis. Aim of the study: To compare the efficacy of Ranson scoring with APACHE II scoring system in predicting the severity of acute pancreatitis. Materials and methods: The present study was a prospective study of 33 cases of Acute pancreatitis admitted in Rajiv Gandhi Government General Hospital, Chennai, during the study period of July 2014 to September 2014. 33 cases for the purpose of the study were selected on the basis of the nonprobability (purposive) sampling method. multiple clinical and laboratory variables of both Ranson and APACHE II scoring system and the final score of the patient from both the scoring systems are assessed to know their efficacy in predicting the severity of the disease (higher the score more severe the disease). Results: Overall, 8(24.2%) patients suffered from severe pancreatitis and 25(75.7%) had mild acute pancreatitis of which all 8 had severe attack as per APACHE II score (>8) and only 3 of these were considered severe by Ranson score (>3). The systemic complications were a multiorgan failure in 2(6.06%), respiratory 1(3.03%) and renal 1(3.03%) all seen in patients with the severe score as per APACHE II. Umarani Subramaniam, Ahila Muthuselvi, Kesavan. A comparative study between APACHE II and Ranson scoring systems in predicting the severity of acute pancreatitis. IAIM, 2019; 6(4): 55-59. Page 56 Conclusion: The early diagnosis and precise scoring of disease severity are important goals in the initial evaluation and management of pancreatitis. Pancreatitis not only must be differentiated from a myriad of other potential diagnoses, but patients must also be stratified to identify those with severe disease and to guide appropriate therapy.

Evaluation of six scoring systems and four laboratory tests in the prognostic assessment of severe acute pancreatitis / 中华消化杂志

Objective To evaluate the six scoring systems and four laboratory tests,including pancreatitis outcome prediction (POP),Ranson score,bedside index for severity in acute pancreatitis (BISAP),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),systemic inflammatory response syndrome (SIRS),and Glasgow score as well as four laboratory tests including C-reactive protein (CRP),hematocrit (HCT),blood urea nitrogen (BUN) and serum creatinine (Scr) in the prognostic assessment of severe acute pancreatitis (SAP).Methods From January 2016 to December 2017,at Sir Run Run Shaw Hospital,151 SAP patients who met the enrollment criteria were retrospectively analyzed.According to the time from onset to treatment,the patients were divided into less than three days group (n=102) and over three days group (n=49).The evaluation of six scoring systems and four laboratory tests,including CRP,HCT,BUN and Scr at 0,24 and 48 h after hospitalization in the prognostic assessment of SAP patients was measured by receiver-operating characteristic (ROC) curve.Results The Ranson score had the highest area under curve (AUC) value (0.916) in the evaluation of the prognosis of SAP patients less than three days group followed by BISAP,APACHE Ⅱ,Glasgow and POP score,and their AUC values were 0.832,0.823,0.793,and 0.787,respectively,all of them were statistically significant in the prognostic assessment of SAP patients in less than three days group (all P＜0.05).There were statistically significant of BISAP and APACHE Ⅱ scores in the prognostic evaluation of SAP patients in over three days group (both P＜0.05),and the AUC values were 0.751 and 0.735,respectively,which were less than those of SAP patients in less than three days group.There were statistical significance of BUN and Scr at 24 and 48 h after hospitalization in the prognostic assessment of SAP patients in less than three days group (all P＜0.05),and the AUC values were 0.856,0.853 and 0.793,0.874,respectively.There were statistical significance of BUN at 0,24,48 h and Scr at 48 h after hospitalization in the prognostic assessment of SAP patients in over three days group (all P＜0.05),and the AUC value was 0.709,0.754,0.742 and 0.716,respectively.Conclusions Ranson,POP and Glascow score systems are only suitable for patients with SAP less than three days.APACHE Ⅱ,BISAP score systems,BUN and Scr can be used to evaluate patients with SAP over three days,but are more suitable for patients with SAP less than three days group.

Ranson's Scoring System and Modified CT Severity Index in the Evaluation of Acute Pancreatitis: A Prospective Hospital Based Study

Background: Acute pancreatitis is an acute abdominal emergency condition that need immediate hospital stay and intensive care. In 80% of cases it runs a mild course and rest of the patients have severe pancreatitis. It's severity is assessed by using Ranson's scoring system and Modified CT severity index. This study was carried out to evaluate role of Ranson's scoring system and modified CT severity index in assessing severity of acute pancreatitis. Methods: - This is a prospective observational study which is conducted on patients with acute pancreatitis admitted in Department of Surgery, Geetanjali Medical College and Hospital, Udaipur. 30 patients of acute pancreatitis enrolled. Ranson's criteria and modified CT severity index apply to all of them. Results: Out of 30 patients, 20 patients have mild pancreatitis. 4 patients have moderate pancreatitis. 6 patients have severe pancreatitis. Conclusion: We conclude that Ranson's criteria and modified CT severity index have significant role in predicting the severity of acute pancreatitis and the chances of developing complications as regards morbidity and mortality.

Comparative study between BISAP and Ransons score in predicting severity of acute pancreatitis

Background: Acute pancreatitis is an acute inflammation of the pancreas is an increasingly common abdominal disorder presenting as major surgical challenge to general surgeons worldwide. Early identification of patients at risk of developing a severe attack has great importance for instituting therapeutic interventions and improved outcome. Accurate prediction of severity is important in order to improve survival. There are several assessment criteria in order to predict prognosis and severity of acute pancreatitis, which help in guiding patient triage and management. However, nothing is proven to perform significantly better in clinical settings than good clinical judgment. Ideal predicting criteria should, therefore be simple, non-invasive, accurate and quantitative and assessment tests are easily available. Aim and objectives: It was a prospective study to assess the accuracy of BISAP scoring system vs Ranson’s scoring system in predicting Severity in an attack of acute pancreatitis and to compare predictability of organ failure, necrosis and mortality between BISAP scoring and Ranson’s Scoring system. Materials and methods: All patients admitted to Govt. Stanley Hospital with complaints of pain abdomen diagnosed to have Acute Pancreatitis on clinical examination and further investigations. Sample size consists of 100 patients with acute pancreatitis. BISAP score and Ranson’s score is calculated in all such patients based on data obtained within 24 hours of hospitalization and at 48 hours. Results: In this study, the two different scoring systems (BISAP and Ranson’s) were compared and analyzed to assess the severity in patients with acute pancreatitis. An attempt also made to compare this study with previous similar studies done by others. Acute pancreatitis found to be 10 times more J. Lalithkumar, T. Chitra, N. Kodieswaran. Comparative study between BISAP and Ranson’s score in predicting severity of acute pancreatitis. IAIM, 2016; 3(9): 23-33. Page 24 common in males than females in this study. The mean length of hospital stay was 12.03 ± 6.8 days in this study. In this study, increasing BISAP and Ranson’s scores was correlated well with the duration of hospital stay. In this study, 86 patients were diagnosed to have mild and moderately severe acute pancreatitis grouped under MAP, and 14 patients found to have severe acute pancreatitis. All the 14 patients were correctly predicted by BISAP score. The scores were assessed by correlating the scores with three factors: organ failure, necrosis and mortality. The analysis for organ failure showed BISAP score has sensitivity of 71.43%, specificity of 95.35%, PPV of 71.43%, NPV of 95.35%, diagnostic accuracy of 92%; whereas Ranson’s score has sensitivity of 78.57%, specificity of 74.42%, PPV of 43.33%, NPV of 95.52 %, diagnostic accuracy of 88%. In this study, 7/20 patients with BISAP> 3 and 8/14 patients with Ranson’s >3, developed pancreatic necrosis. The statistical analysis for the prediction of necrosis has sensitivity of (81.82%, 90.91%), specificity of (94.35%, 77.53%), PPV of (64.29%, 43.56%), NPV of (97.67%, 98.57%), diagnostic accuracy of (93%, 91%) for BISAP and Ranson’s respectively. In this study, 4 patients with severs acute pancreatitis were expired. All 4 deaths were correctly predicted by BISAP score. The statistical analysis for the prediction of necrosis has sensitivity of (100%, 88.57%), specificity of (95.83%, 64.42%), PPV of (50%, 31.33%), NPV of (100%, 96.52%), diagnostic accuracy of (96%, 93%) for BISAP and Ranson’s respectively. In this study, patients developed pancreatic necrosis, acute renal failure, MODS, septicemia. These complications were more likely seen in patients with BISAP ≥ 3, and Ranson’s > 3, hence concluded that these are the patients in high risk group, who requires intensive monitoring and probably early intervention if necessary. Conclusion: From this study, alcohol (59%) was found to be the most common etiological factor for acute pancreatitis. Males were more commonly affected than females with a ratio of 10:1. The most common age groups of patients affected were in 4th decade of life. The overall mortality in patients with severe acute pancreatitis was 4% BISAP score is equally effective in finding out the frequency of severity and predicting mortality in patients with acute pancreatitis as Ranson's score. Moreover, its components are easily available and it does not require 48 hours for completion of assessment as compared to Ranson's score. It is an accurate tool to classify patients into mild and severe disease; it is easy to perform and can be done on the bedside of patients with acute pancreatitis in every setup.

Clinical profile of Acute Pancreatitis in Malwa region of Punjab and its correlation with Balthazar CT Severity Index

Background: Acute pancreatitis is a common condition with wide clinical variation, ranging from mild self-limiting pancreatic inflammation to extensive pancreatic necrosis with life-threatening consequences. The present study aimed to assess the clinical profile of acute pancreatitis in Malwa region of Punjab where there increased prevalence of alcoholism and gall stone disease and to assess the efficacy of Ranson’s score and Balthazar Computed tomography severity index (CTSI) in predicting the prognosis. Materials and methods: 50 patients with proven acute pancreatitis were included and data was collected to study their clinical, laboratory and radiologic profile to obtain prognostic indices Ranson’s score and CTSI which were then compared with outcome. Results: Mean age recorded was 43.40 ±12.004 years with a range of 19-64 years and male to female ratio 2.12:1. 62% of patients had alcohol induced pancreatitis and 32% had gall stone pancreatitis. Observed morbidity rate was 44% and mortality rate was 6%. Most common complications encountered were pleural effusion (18%), Hypocalcemia (20%) and sterile pancreatic necrosis (20%). 18 patients had Ranson’s score more than 3, whereas 11 patients had CTSI more than 7 indicating severe acute pancreatitis. On correlation Ranson’s score was found to be more sensitive while CTSI was more specific for an adverse outcome. Conclusion: Severe acute pancreatitis remains a significant cause of morbidity and mortality due to increased prevalence both alcoholism and gall stone disease in Malwa region of Punjab. In our setup Ranson’s score and CTSI when used in combination showed improved sensitivity for detection severe acute pancreatitis.

Comparative analysis of clinical features of non-acute biliary pancreatitis and acute biliary pancreatitis / 中国综合临床

Objective To explore the etiological factors,clinical characteristic and diagnosis of nonacute biliary pancreatitis (NABP) and acute biliary pancreatitis (ABP).Methods The Clinical data of 152 patients with NABP and 206 patients with ABP from January 2004 to December 2014 in the Hepatobiliary Surgery Department of Jinshan Branch of the Sixth People's Hospital of Shanghai were analyzed retrospectively.Results There were no statistically significant differences in terms of the Ranson score,blood amylase and C reactive protein (CRP) between two groups (P ＞ 0.05).The incidences rate of hepatic insufficiency,renal insufficiency and encephalopathy were 35.5％ (54/152),25.6％ (39/152) and 8.5％ (13/152) in the NABP group,and 25.7％(53/206),12.1％(25/206) and 3.3％(7/206) in the ABP group,with significant difference between the two groups (x2 =4.01,10.89,4.41;P ＜ 0.05).Conclusion The key to reduce the complications and improve the cure rate is to make clear the etiology of NABP and ABP and to take active and effective treatment for the cause of the disease.

The role of four criteria in assessment of the severity and prognosis of hyperlipidemic acute pancreatitis / 中华内科杂志

Objective To explore the four criteria,including bedside index for severity in acute pancreatitis(BISAP),Ranson score,modified CT severity index(MCTSI) and acute physiology and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) in assessment of severity and prognosis of hyperlipidemic acute pancreatitis.Methods A total of 326 patients with hyperlipidemic acute pancreatitis were studied retrospectively from August 2006 to July 2015.The discrepancy of the four criteria in assessment of severity and prognosis of hyperlipidemic acute pancreatitis was compared with chi-square test and receiver operating characteristic curve.Results The incidences of moderately severe acute pancreatitis and severe acute pancreatitis,local complications and mortality of patients with BISAP score ≥3,Ranson score ≥3,APACHE Ⅱ score≥8 and MCTSI score≥4 were significantly higher than BISAP score ＜ 3,Ranson score ＜ 3,APACHE Ⅱ score ＜ 8 and MCTSI ＜ 4 respectively (all P ＜ 0.05).As far as severity was concerned,the sensitivity and AUC of APACHE Ⅱ were 57％ and 0.814,which were higher than the other systems.The second most sensitive criterion was BISAP.In assessment of local complications,the sensitivity and AUC of MCTSI were 68％ and 0.791,which were higher than the other three.The most sensitive criterion to predict mortality was BISAP with sensitivity 89％ and AUC 0.867,which was followed by APACHE Ⅱ.Conclusions All four criteria can be used to determine the severity,local complications and mortality.Generally,BISAP is simple and easy to practice,and better than the other three.

Clinic significance of four clinical scoring systems in evaluating prognosis of acute pancreatitis / 天津医药

Objective To compare the clinic significance of four clinical scoring systems in evaluating prognosis of acute pancreatitis: bedside index for severity in acute pancreatitis(BISAP), acute physiology and chronic health evaluation (APACHEⅡ), Ranson’s scoring system, computed tomography severity index (CTSI) in AP. Methods Patients visited our clinic with AP (n=114) in recent 2 years were retrospectively analyzed. BISAP and APACHEⅡscores were obtained at 24 hours after admission; Ranson ’s score was obtained at 48 hours after admission and CTSI are obtained was obtained at 72 hours after admission. Results of four scoring system were compared under different causes and different severity of the dis?ease. Correlation between BISAP score and the other three scores were analyzed and the predicative value of all four scoring systems for severity of AP and death were also compared. Results The mean values of four scoring systems show no signifi?cant difference in AP patients with different etiology (P>0.05). The BISAP score is positively correlated with APACHE-Ⅱ, Ranson ’s score and CTSI score (P<0.01). The four scoring systems all present good predictive value on the severity of AP and death (P<0.01). Conclusion The four scoring systems can all be applied to grading and prognosis for AP of various causes. BISAP is a simple, prompt, economical scoring system in clinical practice.

Comparison of BISAP, Ranson's, APACHE Ⅱ and CTSI scores in evaluating the severity of acute pancreatitis / 中华消化外科杂志

Objective To investigate the value of the bedside index for severity in acute pancreatitis (BISAP),Ranson's,APACHE Ⅱ and computed tomography severity index (CTSI) scoring system in evaluating the severity of acute pancreatitis.Methods The clinical data of 385 patients with acute pancreatitis who were admitted to the Zhongnan Hospital of Wuhan University from 2005 to 2011 were retrospectively analyzed.The values of 4 scoring systems including BISAP,Ranson's,APACHE Ⅱ and CTSI in predicting the incidences of severe acute pancreatitis,local complications and death were investigated by Chi-square test and receiver operating characteristic curv e.Odds ratio (OR) was calculated.The differences of areas under the curves (AUC) were analyzed using the Z test.Results The incidences of severe acute pancreatitis,local complications and mortality of patients with BISAP score ≥ 3 were 64.4％ (56/87),16.1％ (14/87) and 8.0％ (7/87),which were significantly higher than 13.4％ (40/298),6.4％ (19/298) and 0.3 ％ (1/298) of patients with BISAP score ≤ 2 (x2 =93.4,8.1,19.7,P ＜ 0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with Ranson's score≥3 were 52.7％ (48/91),22.0％ (20/91) and 7.7％ (7/91),which were significantly higher than 16.3％ (48/294),4.4％ (13/294) and 0.3％ (1/294) of patients with Ranson's score ≤2 (x2 =49.2,27.3,18.5,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with APACHE Ⅱ score ≥ 8 were 46.6％ (27/58),20.7％ (12/58) and 8.6％ (5/58),which were significantly higher than 21.1％ (69/327),6.4％ (21/327) and 0.9％ (3/327) of patients with APACHE Ⅱ score≤7 (x2 =17.0,12.8,14.4,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with CTSI score ≥4 were 51.4％ (19/37),51.4％ (19/37),16.2％ (6/37),which were significantly higher than 22.2％ (77/347),4.0％ (14/347),0.6％ (2/347) of patients with CTSI score≤3 (x2 =15.1,95.3,40.1,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 58％,89％,64％,86％,respectively,and the AUC was 0.848,which were significantly higher than the other 3 systems (Z =2.02,4.22,4.78,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of CTSI were 58％,95％,51％ and 96％,respectively,and the AUC was 0.926,which was significantly higher than the other 3 systems (Z =3.99,3.24,4.06,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 88％,79％,8％ and 100％,respectively,and the AUC was 0.855,with no significant difference compared with the other 3 systems (Z =0.81,0.03,0.14,P ＞ 0.05).Conclusions The accurate rate of BISAP in predicting the severe acute pancreatitis is higher than Ranson's,APACHE Ⅱ and CTSI.The accurate rate of CTSI in predicting the incidence of local complications is higher than the other 3 systems.There is no significant difference of the 4 systems in predicting the mortality.The BISAP scoring system is helpful in early diagnosis of severe acute pancreatitis,and making the individualized treatment plan,thus improving the prognosis of patients.

Significance of procalcitonin in judgment of disease situation of acute pancreatitis / 中国中西医结合急救杂志

Objective To approach the significance of procalcitonin(PCT)in judgment of the degree of severity in patients with acute pancreatitis(AP). Methods A prospective method was conducted in the study. Ninety-eight patients with AP admitted from April 2013 to December 2013 in the First Affiliated Hospital of Zhengzhou University were enrolled. They were divided into mild AP(MAP,48 cases)and severe AP(SAP,50 cases)groups, biliary AP(58 cases)and non biliary AP(40 cases)groups,and biliary SAP and biliary MAP groups,non biliary SAP and non biliary MAP groups. The venous blood levels of PCT on the first day and second day after admission were assayed for all the patients,and the correlations between PCT levels on the two time points respectively and each of the following items were calculated:Ranson score,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,CT grade,number of organ dysfunction,intensive care unit(ICU)time of stay and total time of hospitalization. Results On the second day after admission,the PCT levels in groups different in etiology and groups different in severity were all elevated and higher than those on the first day,the level in SAP group being significantly higher than that of MAP group〔3.723(2.538,9.023)vs. 0.282(0.166,1.348),P0.05〕,the level in biliary SAP group being higher than that in biliary MAP group〔4.023(3.273,10.015)vs. 0.305 (0.244,1.413),P<0.01〕,and the level in non biliary SAP group being higher than that in non biliary MAP group〔3.624(2.454,8.993)vs. 0.256(0.144,1.137),P<0.01〕. The correlations between PCT levels on the first day and second day after admission and each of the following items were respectively as follows:the correlations with Ranson score〔relative risk (RR1)=0.643,P1=0.001,95% confidence interval(95%CI1):0.435-1.596;RR2=0.762, P2=0.001,95%CI2:0.692-1.541〕,APACHE Ⅱ score(RR1=0.543,P1=0.009,95%CI1:0.842-1.512;RR2=0.672,P2=0.001,95%CI2:0.747-1.234)and CT grade(RR1=0.231,P1=0.048,95%CI1:0.596-1.412;RR2=0.256,P2=0.032,95%CI2:0.702-1.324)were all positive;the higher the number of organ dysfunction,the higher the level of PCT(RR1=0.321,P1=0.023,95%CI1:0.763-2.588;RR2=0.389,P1=0.020,95%CI2:0.683-1.742);the level of PCT had relatively favorable correlation with ICU time of stay(RR1=0.423,P1=0.019,95%CI1:0.779-1.459;RR2=0.453,P2=0.010,95%CI2:0.684-1.853),but there was no correlation between the level and the total time of hospitalization(RR1=0.004,P1=0.067,95%CI1:0.864-2.071;RR2=0.009,P2=0.078,95%CI2:0.645-1.376). Conclusion The level of PCT can be used in judgment of the degree of severity of the patients with AP,not only it can be applied in patients biliary in origin,but also can be used in patients non biliary in origin.

Hemoconcentración, apache II y ranson como predictores tempranos de severidad en pacientes con diagnóstico de pancreatitis aguda en un Hospital de Lima - Perú / Hemoconcentration, apache II and ranson as early predictors of severity in patients with acute pancreatitis in a hospital in Lima - Peru

OBJETIVO: Comparar hemoconcentración y sistemas de puntuación APACHE II y Ranson como predictores tempranos de severidad determinada por criterios de Atlanta en pacientes con diagnóstico de Pancreatitis Aguda en el Hospital Nacional Cayetano Heredia. MATERIALES Y MÉTODOS: Estudio descriptivo retrospectivo entre diciembre del 2009 a noviembre del 2010 con una ficha de recolección de datos para obtener la información relevante. Se clasificó los cuadros de pancreatitis aguda en leve y severa en base a los criterios de falla orgánica y/o complicaciones locales según el Simposio de Atlanta. Para la comparación del valor de hematocrito se realizó la prueba t de Student para evaluar una diferencia significativa y se elaboró la curva ROC para las áreas bajo la curva. RESULTADOS: Ingresaron al estudio 151 pacientes, 103 mujeres (68.2%), edad promedio de 45.5 ± 19.17 años, 112 pancreatitis leves (74.2%) y 39 severas (25.8%). El hematocrito promedio en los casos leves fue de 38.40 ± 4.77%, y 39.78 ± 7.35% en los severos con p igual a 0.182. Se encontró un área bajo la curva de 0.89 y 0.68 para score APACHE II y Ranson, respectivamente. CONCLUSIÓN: Hemoconcentración y Ranson no son buenos predictores de severidad comparados con el APACHE II en Pancreatitis Aguda.

OBJECTIVE: Compare hemoconcetration, APACHE II and Ranson scores as early predictors of severity defined by Atlanta criteria in patients with acute pancreatitis at Hospital Nacional Cayetano Heredia. MATERIALS AND METHODS: Retrospective descriptive study between December 2009 to November 2010 done using a data collection sheet to gather study relevant information. We classified acute pancreatitis into mild or severe according to Atlanta symposium criteria for organ failure and/or local complications. Comparison of hematocrit values was made using a t Student test to detect a significant difference and the area below the ROC curve was analyzed. RESULTS: Counting with 151 patients, 103 women (68.2%), with mean age of 45.5 ± 19.17 years, 112 mild pancreatitis (74.2%) and 39 severe (25.8%). Mean hematocrit in mild cases was 38.40 ± 4.77% and 39.78 ± 7.35% in severe group with p equal to 0.182. Area below the ROC curve of 0.89 y 0.68 for APACHE II and Ranson scores respectively. CONCLUSION: Hemoconcentration and Ranson proved not to be as useful as APACHE II score in predicting severity in acute pancreatitis.

Value of bedside index for severity in acute pancreatitis scoring system in diagnosing severe acute pancreatitis / 中华胰腺病杂志

Objective To evaluate the value of the Bedside Index for Severity in Acute Pancreatitis (BISAP) in diagnosing severe acute pancreatitis. Methods Sixty-eight patients with suspected diagnosis of severe acute pancreatitis were collected and were scored by BISAP, APACHE Ⅱ , Ranson and CTSI scoring systems, respectively. BISAP scoring system included the blood urea nitrogen, impaired mental status,systemic inflammatory response syndrome, age, and pleural effusion. The diagnosis criteria of severe acute pancreatitis was BISAP ≥ 3 points or APACHE IⅡ ≥ 8 points, Ranson ≥ 3 points, CTSI ≥ 3 points. The diagnostic accuracy of SAP of these scoring systems was calculated. Results Among these 68 cases, 63.2％(43/68) were graded ≥ 3 points in BISAP scoring system;60.3％ (41/68) were marked ≥8 points in APACHE Ⅱ scoring system; 60.3％ (41/68) were scored ≥ 3 points in Ranson scoring system; and 67.6％(46/68) were scored ≥3 points in CTSI scoring system. There was no statistical difference between BISAP scoring system and other three scoring systems in diagnosing severe acute pancreatitis. Conclusions As a new and simple scoring system, BISAP scoring system can be widely used in the diagnosis of severe acute pancreatitis.

Clinical features of acute hyperlipidemic pancreatitis / 中华胰腺病杂志

Objective To analyze the clinical features of acute hyperlipidemic panereatitis,and to investigate the therapeutic strategies.Methods In this retrospective study,44 patients with hyperlipidemic pancreatitis admitted to our hospital from January 2003 to December 2007 were enrolled,60 patients with acute pancreatitis of other etiologies were enrolled as the control group.Results The proportions of patients with overweight or obesity,hyperglycemia,fatty liver and hypertension were 81.8%,59.1%,54.5% and 68.2%,respectively;these were significantly higher than those in control group,which were 16.7%,16.7 %,13.3 % and 23.3 %,respectively (P＜0.05 or＜0.01).The proportion of patients with lithiasis was lower in HLP group than that in control group (13.6% vs 60.0%,P＜0.05).There was no difference in the proportions of patients with chronic alcoholism between two groups.The Ranson score,CTSI,complications in HLP group were 3.15±0.07,4.46±2.58 and 3.2±1.7,respectively;these parameters were significantly higher than those in control group,which were 1.62±0.22,2.62±1.90 and 0.9±1.2 (P＜0.05 or ＜ 0.01 ).The level of serum amylase in HLP group was 580±222 mmol/L,which was significantly lower than that of control group (1361±472 mmol/L,P ＜ 0.01 ).The triglyceride (TG) level was linearly correlated with Ranson score in HLP group ( r = 0.77,P ＜ 0.05 ),but there was no linear correlation between TG level and Ranson score in the control group.Conclusions There was a close relationship between HLP and metabolic syndrome.Serum TG was positively correlated with the severity of HLP.

Study on the application of modified early warning score system in patients with acute pancreatitis / 中华急诊医学杂志

Objective To evaluate the modified early warning score (MEWS) system in the assessment of the severity and prognosis in acute pancreatitis (AP). Method Ninety two AP patients had been recruited from the Department of Emergency Medicine during November, 2007 to May, 2008. All patients fulfilled at least 2 of the three criteria of American AP clinical guideline, (1) typical abdominal pain; (2) serum amylase level ≥3times of upper normal limit; (3) typical ultrasound or CT findings for AP. Patients with cardiac, pulmonary, hepatic , renal insufficiency or other comorbidities were ruled out. Each patient was evaluated MEWS at day 1,2, and 3 after admission, and subsequently stratified into two groups: high risk group with MEWS ≥4 and moderate risk group with MEWS < 4. The clinical course, end organ failure, and mortality rate was compared between two groups. Other parameters including Ranson score, APACHE Ⅱ score were also obtained. Spearman correlation,group student t test, or Chi square tests were used. Results High risk group has significant prolonged clinical course ( P < 0.05 ) , higher end organ failure rate (P < 0.01) , compared to low risk group. Patients who can not achieve MEWS improvements after interventions have the highest mortality rate (P < 0.01). The MEWS positively correlated with Ranson and APACHE Ⅱ scores ( r = 0.486, and 0.583, respectively, P <0.05). Conclusions MEWS is a valid and simple tool to evaluate severity and prognosis of AP in early stage.

A clinical study on relationship between hypertriglyceridemia and acute pancreatitis / 临床外科杂志

Objective To evaluate the relationship between hypertriglyceridemia and acute pancreatitis.Methods Data was analyzed from 41 patients with acute pancreatits from Apr.1998 to Oct.2000 in our hospital.Of the 13 patients(GroupⅠ) with plasma TG level being higher than 11.3 mmol/L, 8 accompanied with gallstone(61.5%)and 5 without gallstone(38.5%)of the 28 patients (GroupⅡ) with plasma TG level being lower than 11.3 mmol/L,19 accompanied with gallstone(47.3%)and 9 without gallstone(52.7%)RANSON score,morbidity of complications and the level of ALT and AST were compared between two groaps.The correlation between TG and RANSON score was analysed.Results There were significant difference between the two groups on RANSON score,morbidity of complications and level of ALT and AST(P0.05).Conclusion There is an close relationship between hypertriglyceridemia and acute pancreatitis,the high level of plasma TG plags a key a role in acute pancreatitis,patients with acute pancreatitis with hypertriglyceridemia are more likely to have higher morbidity of complications and liver function aggravating.

Etiology and Analysis of Severity in Childhood Pancreatitis / 대한소아소화기영양학회지

PURPOSE: Childhood pancreatitis has more various and somewhat different etiology than adult. Until now the analysis of severity in childhood pancreatitis were not well-known, although several studies have been made. Therefore, we studied the etiology and complications in childhood pancreatitis and analyzed whether Ranson and CT criteria could be applicated to evaluate the severity of childhood pancreatitis patients. METHODS: The records of 30 patients with pancreatitis under 15 years of ages who were diagnosed in Asan medical center were reviewed. Age, sex, history, etiology, clinical features and treatment was reviewed in all patients but complications, Ranson and CT criteria were available in only 12 patients. Correlation between the number of complications and both Ranson and CT criteria were calculated with Spearman correlation coefficient. RESULTS: 1. Median age at diagnosis was 7.3 years of age. 28 cases were acute pancreatitis and 2 cases were chronic pancreatitis. 2. Etiology: choledochal cyst(8 cases), drug (7 cases), trauma (4 cases), infection (3 cases), biliary stone or bile sludge (3 cases), idiopathic (2 cases) Hemolytic uremic syndrome, pancreatic duct obstruction, iatrogenic (1 case). 3. Local complications were ascites (5 cases), pseudocyts (4 cases) and systemic complications were hyperglycemia (4 cases), hypocalcemia (3 cases), pleural effusion (3 cases), etc. 4. Positive correlation was found between the number of complication and Ranson creteria (r=0.78, P=0.0016) and between the number of complication and CT criteria (r=0.65, P=0.015) in 13 cases. CONCLUSION: A trial to search the biliary duct anomaly may help to find the causes of childhood idiopathic pancreatitis, and both Ranson and CT criteria can be applicated to pediatric patients to evaluate the severity of childhood pancreatitis.