BACKGROUND: Acute pancreatitis is one of the most common cause of abdominal pain. About 10to 20% of patients will progress to Severe Acute Pancreatitis (SAP) with a mortality rate of 6 to 10 %.Individual patient’s response to pancreatitis is highly variable. Because of this, it is of utmost importance to predict who is at the risk of developing severe pancreatitis as this will help to institute more intensive treatment. This will in turn improve the mortality. For this purpose various scoring systems are used. This study compares the strength of various prognostic factors in assessing the severity of acute pancreatitis. We also compared the sensitivity and specificity of various scoring systems in assessing the severity and mortality of acute pancreatitis.
METHODS: A prospective, observational, clinical and investigational study was
carried out in 50 patients admitted with acute pancreatitis in Government Rajaji
Hospital Madurai. Twelve individual parameters -Age, WBC count, RBS, Blood
Urea, S.Creatinine, PaO2, S.Calcium, S.LDH, S.bilirubin, S.Albumin, S.AST and
S.ALT were assessed for their strength of association with severity of acute
pancreatitis. Five scoring systems APACHE II, Ranson’s, Imrie’s, Bank’s,
Pitchumani & Agarwal system were compared for their sensitivity and specificity
for assessing the severity and mortality of acute pancreatitis.
RESULTS: Among the 50 patients 18 patients developed Severe Acute Pancreatitis
(SAP) marked by evidence of end organ failure, local complications like
psuedocyst, and /or prolonged ICU stay of more than 7 days. Among this 8 patients
died. Among the individual parameters B.Urea,S.Creatinine, PaO2 and WBC count,
Age, S.Calcium and S.LDH levels showed a significant association with severity of acute pancreatitis. APACHE II systems had a sensitivity of 77.78% and specificity of 96.88% in predicting severity. Sensitivity and specificity of Ranson’s score was 83.33% and 96.88% respectively. Imrie’s score had a sensitivity of 55% and specificity of 100% .Both Bank’s score and Pitchumani score had comparatively low sensitivity and specificity.
Conclusion: APACHE II score and Ranson’s score are the best scoring systems in
predicting the severity of acute pancreatitis. Among individual parameters Hypoxia, Acute renal failure, leukocytosis, advancing age, hypocalcemia and increase in serum LDH levels were the factors significantly associated with Severe Acute Pancreatitis (SAP)
