Comparison Of Scoring Systems In Predicting Severity And Prognosis Of Acute Pancreatitis

Objectives:According to revision of the Atlanta classification in 2012,we compared the diagnostic value of different scoring systems for the severity and prognosis of AP by retrospective study,to provide a clinical basis for diagnosis and treatment of AP.Methods:A retrospective analysis of clinical data of department of Gastroenterology,gastrointestinal surgery,department of hepatobiliary surgery,critical care medicine and department of emergency the Second Affiliated Hospital of Kunming Medical University 185 cases of patients with AP from Jan 2012 to Dec 2017.Respectively calculate with PANC3?HAPS?Ranson?CTSI?BISAP scores.To carry out each were there some differences of the point in these scoring systems based on the 1992 and 2012 revision of the Atlanta classification.Draw the scoring systems of the receiver operating characteristic curve,compare each of their value of severity of disease prediction,local complications,organ failure and death.Determine the best critical value of the scoring systems in the light of their AUC.Using the Logistic correlation analysis to determine the correlation between complication and death,to determine the independent risk factors of AP death.Results:1.A total of 185 cases were selected,including 110 males(59.5%)and 75(40.5%)women(40.5%)with an average age of 59.39 ± 17.10,and the average hospitalization time was 18.83 ± 19.65 days,153 cases(82.7%)were improved,32 cases were died(17.3%).General data statistics:the Gallstone group 78 cases(42.2%),hyperlipidemia group 55 cases(29.7%),35 cases of alcoholic group(18.9%)and other pathogeny group were 17 cases(9.2%).According to the Atlanta classification standard in 1992,there were 58 cases in group MAP and 127 cases in SAP group.According to revised Atlanta classification in 2012,the group of MAP were 58 cases,the group of MSAP were 66 cases and group of SAP were 61 cases.2.Statistics of organ failure occurred in SAP:under the Atlanta classification in 2012,the incidence of organ failure in group SAP was significantly higher than that in group SAP under the Atlanta classification in 1992.The number and the largest proportion of cases of circulatory failure were 106 cases(83.5%).The number of cases of respiratory failure and renal failure is the same with 91 cases(71.6%).3.Correlation analysis between common complications and AP mortality:the OR values of SAP combined with gastrointestinal bleeding,renal insufficiency and adult respiratory distress syndrome were 4.375,12.846,3.212(P<0.05),indicating that there was a significant correlation between the above 3 factors and AP mortality.The OR value of pancreatic pseudocyst was 1.165,close to 1,(P>0.05).There was no correlation between the pancreatic pseudocyst and AP death.4.Different scoring systems of SAP disease severity score statistics:under the Atlanta classification in 2012,SAP group PANC-3,HAPS,Ranson,BISAP and CTSI score were significantly higher than that of MSAP group;the differences were statistically significant(P<0.00).In 1992,the five scores of group SAP were significantly lower than those of group SAP under Atlanta classification in 2012,the difference between them was statistically significant(P<0.00).5.Correlation analysis between the different scoring systems and SAP:PANC3,Ranson,CTSI and BISAP were significantly correlated with SAP(P<0.05),HAPS score had no correlation with SAP(P value>0.05),The accuracy of the HAPS score for the prediction of MAP was 96.6%.6.The diagnostic value of different scoring systems predicting SAP:under the Atlanta classification in 1992 and 2012,the AUC,Yorden index and specificity of PANC3 score in predicting SAP were higher than other scoring systems,It has significant advantages.under the Atlanta classification 1992,PANC3 score was AUC(0.942),Yorden index(0.751),and the specificity was 94.8%.In the revised Atlanta classification in 2012,PANC3 score with its AUC value(0.920),Jorden index(0.632),specificity 97.6%,and according to the Jorden index,its best diagnostic value was 2 point.7.Compare the diagnostic value of different scoring systems in preceding AP combine local complications,organ failure and death:The diagnostic value of CTSI?4 with its AUC(0.920),Yorden index(0.689),and the specificity(93.2%)in predicting AP local complications is higher than other scoring systems.Ranson ? 4 its AUC(0.852),Yorden index(0.551),and the specificity(98.6%)in predicting the diagnostic value of AP organ failure is higher than other scores,and BISAP ? 3 score its AUC(0.918),Yorden index(0.752),and the specificity(90.8%)is more valuable in predicting AP death than other scoring systems.8.Comparison of different scoring systems for incidence rate of evaluating AP combine local complications,organ failure and death:In the assessment the incidence of AP prognosis,PANC3 ? 2,Ranson ? 4,CTSI ? 4,BISAP ? 3 the percentage of groups were significantly higher than those groups with PANC3<2,Ranson<4,CTSI<4,BISAP<3.CTSI ? 4 with its incidence rate(94.4%)and OR(11.33)was significantly higher than other scores in evaluating AP local complication,Ranson ?4 with its incidence rate(98.5%)and OR(40.174)was significantly higher than other scores in evaluating AP organ failure,BISAP ?3 with its OR(53.696)was significantly higher than other scores in evaluating AP death.Conculsion:1.The revised Atlanta classification standard in 2012 can better respond to changes in AP condition.2.SAP combined with gastrointestinal bleeding,renal insufficiency,and adult respiratory distress syndrome are the independent risk factor for the AP death.3.The accuracy of HAPS score in predicting MAP has more advantages than other scoring systems.4.The value of the PANC3 score for the early prediction of SAP was better than the other scoring systems under the Atlanta classification in 1992 and 2012,and the best diagnostic value was 2 point.5.Under the revised Atlanta classification in 2012,Ranson ? 4 in the diagnosis of sustainability organ failure prediction of AP value and its accuracy is better than the other scoring systems,its best diagnostic value is different from Ranson ?3 under the Atlanta classification in 1992.6.Under the revised Atlanta classification in 2012,CTSI?4 in the diagnosis of local complications of AP prediction value has a significant advantage,for the revised Atlanta classification in 2012,its best diagnostic value did not change.7.Under the revised Atlanta classification in 2012,BISAP ?4 was obviously better than other scoring systems in prediction value of AP death,its best diagnostic value did not change.