A Comparative Study On Three Clinical Scoring Systems In The Prediction Of Severity And Prognosis Of Acute Pancreatitis

Objective To evaluate and compare the value of Bedside Index for Severity in Acute Pancreatitis(BISAP),Acute Physiology And Chronic Health Evaluation II(APACHEII),Ranson scoring systems in predicting the severtity and prognosis of acute pancreatitis,and provide evidence for applying the scoring systems to guide clinical judgement and treatment.Methods One hundred and sixty-one patients with acute pancreatitis (AP) admitted into Fujian Provincial Hospital from January 2007 to October 2010 were retrospectively studied with BISAP,APACHEII and Ranson scoring systems. Receiver operator characteristic curve was used to compare the values of APACHEII,BISAP and Ranson socring systems in predicting severity and prognosis of acute pancreatitis.The relationship between the three scoring systems and duration of fasting and hospitalization was analyzed.Results Among 161 patients ,51 patients were identified in mild acute pancreatitis while 110 patients were identfied in severe acute pancreatitis.The scores(mean±stan- dard deviation) of three scoring systems between mild acute pancreatitis and severe acute pancreatitis. were different (p<0.00).The scores of three scoring systems were correlated significantly with duration of fasting and hospitalization.Through the comparison of the area under receiver operator characteristic curve:APACHEII had a higher ability in predicting severity and systemic complications compared to other two scoring systems (p<0.05),the area under receiver operator characteristic curve of APACHEII in predicting severity and systemic complications were 0.897 and 0.899 respectively.Ranson scoring systems had a higher ability in predicting local complications as the cut-piont was no less than 5.BISAP scoring system could predict the severity and prognosis of AP,.The sensitivty of BISAP which was better than other two scoring systems in predicting mortality was 0.953 as the cut-piont was no less than 3. Conclusion The predictive ability of the three scoring systems is not the same,APACHEII scoring system had a higher ability in predicting severity and multiple organ dysfunction syndrome while Ranson scoring system had a higher ability in predicting local complications;BISAP is a simple and useful scoring system, and had a higher ability in predicting mortality of patients with AP,but has no obvious advantages than other two scoring systems in predicting the severity and prognosis of AP.