Comparison of scoring systems in predicting the severity of acute pancreatitis

AIM: To investigate the prognostic usefulness of several existing scoring systems in predicting the severity of acute pancreatitis (AP). METHODS: We retrospectively analyzed the prospectively collected clinical database from consecutive patients with AP in our institution between January 2011 and December 2012. Ranson, Acute Physiology and Chronic Health Evaluation (APACHE)-Pi, and bedside index for severity in acute pancreatitis (BISAP) scores, and computed tomography severity index (CTSI) of all patients were calculated. Serum C-reactive protein (CRP) levels were measured at admission (CRPi) and after 24 h (CRP24). Severe AP was defined as persistent organ failure for more than 48 h. The predictive accuracy of each scoring system was measured by the area under the receiver-operating curve (AUC). RESULTS: Of 161 patients, 21 (13%) were classified as severe AP, and 3 (1.9%) died. Statistically significant cutoff values for prediction of severe AP were Ranson >= 3, BISAP >= 2, APACHE-Pi >= 8, CTSI >= 3, and CRP24 >= 21.4. AUCs for Ranson, BISAP, APACHE-Pi, CTSI, and CRP24 in predicting severe AP were 0.69 (95% CI : 0.62-0.76), 0.74 (95% CI : 0.66-0.80), 0.78 (95% CI : 0.70-0.84), 0.69 (95% CI : 0.61-0.76), and 0.68 (95% CI : 0.57-0.78), respectively. APACHE-Pi demonstrated the highest accuracy for prediction of severe AP, however, no statistically significant pairwise differences were observed between APACHE-Pi and the other scoring systems, including CRP24. CONCLUSION: Various scoring systems showed similar predictive accuracy for severity of AP. Unique models are needed in order to achieve further improvement of prognostic accuracy.