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Comparison of Scoring Systems in Predicting Severity and Prognosis of Hypertriglyceridemia-Induced Acute Pancreatitis

  • Man Li
  • Xiao-kang Xing
  • Zhi-hua Lu
  • Feng GuoEmail author
  • Wei Su
  • Yong-jun Lin
  • Dong-hai Wang
Original Article
  • 8 Downloads

Abstract

Background

In China, hyperlipidemia is the second major reason of acute pancreatitis.

Aims

Comparison of Scoring Systems in identification patients at risk for severe acute pancreatitis (SAP), pancreatic necrosis (PNec), and infected pancreatic necrosis (IPN) early in the course of hypertriglyceridemia-induced acute pancreatitis (HTG-AP).

Methods

Predictive accuracy of scoring systems was measured by the area under the receiver operating characteristic curve (AUC) in a retrospective study. Pairwise AUC comparisons were performed to calculate the difference between scoring systems.

Results

A total of 238 patients diagnosed with HTG-AP were included. Sixty patients (25.2%) were classified as SAP. Twenty-nine patients (12.2%) had evidence of PNec. Nine patients (3.8%) were diagnosed with IPN. One patient (0.4%) died during hospitalization. In predicting SAP in HTG-AP, the AUCs of APACHE-II, SOFA, SIRS, Ranson’s, BISAP, and MMS were 0.77, 0.83, 0.73, 0.88, 0.83, and 0.85, respectively; in predicting PNec, were 0.75, 0.77, 0.75, 0.86, 0.80, and 0.75, respectively; and in predicting IPN, were 0.92, 0.86, 0.76, 0.85, 0.84, and 0.87, respectively. Pairwise AUC comparisons revealed that Ranson’s, MMS, BISAP, and SOFA had higher accuracy than SIRS, Ranson’s and MMS had higher accuracy than APACHE-II in predicting SAP; Ranson’s had the same accuracy with BISAP, but higher than other four criteria in predicting PNec; APACHE-II had higher accuracy than SIRS in predicting IPN.

Conclusions

APACHE-II had high performance in predicting IPN, and all other score systems had medium performance in predicting SAP, PNec, and IPN in HTG-AP. Each score has its merit and weakness; BISAP may be the best criterion in predicting severity and prognosis of HTG-AP.

Keywords

Hypertriglyceridemia Severe acute pancreatitis Pancreatic necrosis Infected pancreatic necrosis 

Notes

Funding

The study was not funded.

Complaince with Ethical Standards

Conflicts of interest

All authors declare no conflicts of interest.

Supplementary material

10620_2019_5827_MOESM1_ESM.xlsx (44 kb)
Supplementary material 1 (XLSX 45 kb)

References

  1. 1.
    Shah AP, Mourad MM, Bramhall SR. Acute pancreatitis: current perspectives on diagnosis and management. J Inflamm Res. 2018;11:77–85.CrossRefGoogle Scholar
  2. 2.
    Nesvaderani M, Eslick GD, Vagg D, Faraj S, Cox MR. Epidemiology, aetiology and outcomes of acute pancreatitis: a retrospective cohort study. Int J Surg. 2015;23:68–74.CrossRefGoogle Scholar
  3. 3.
    de Pretis N, Amodio A, Frulloni L. Hypertriglyceridemic pancreatitis: epidemiology, pathophysiology and clinical management. United Eur Gastroenterol J. 2018;6:649–655.CrossRefGoogle Scholar
  4. 4.
    Rawla P, Sunkara T, Thandra KC, Gaduputi V. Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies. Clin J Gastroenterol. 2018;11:441–448.CrossRefGoogle Scholar
  5. 5.
    Carr RA, Rejowski BJ, Cote GA, Pitt HA, Zyromski NJ. Systematic review of hypertriglyceridemia-induced acute pancreatitis: a more virulent etiology? Pancreatology. 2016;16:469–476.CrossRefGoogle Scholar
  6. 6.
    Zheng Y, Zhou Z, Li H, et al. A multicenter study on etiology of acute pancreatitis in Beijing during 5 years. Pancreas. 2015;44:409–414.Google Scholar
  7. 7.
    Chang MC, Su CH, Sun MS, et al. Etiology of acute pancreatitis–a multi-center study in Taiwan. Hepatogastroenterology. 2003;50:1655–1657.Google Scholar
  8. 8.
    Qiu L, Sun RQ, Jia RR, et al. Comparison of existing clinical scoring systems in predicting severity and prognoses of hyperlipidemic acute pancreatitis in chinese patients: a retrospective study. Medicine (Baltimore). 2015;94:e957.CrossRefGoogle Scholar
  9. 9.
    Yang L, Liu J, Xing Y, et al. Comparison of BISAP, Ranson, MCTSI, and APACHE II in Predicting Severity and Prognoses of Hyperlipidemic Acute Pancreatitis in Chinese Patients. Gastroenterol Res Pract. 2016;2016:1834256.Google Scholar
  10. 10.
    Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111.CrossRefGoogle Scholar
  11. 11.
    Adiamah A, Psaltis E, Crook M, Lobo DN. A systematic review of the epidemiology, pathophysiology and current management of hyperlipidaemic pancreatitis. Clin Nutr. 2018;37:1810–1822.CrossRefGoogle Scholar
  12. 12.
    Cavestro GM, Leandro G, Di Leo M, et al. A single-centre prospective, cohort study of the natural history of acute pancreatitis. Dig Liver Dis. 2015;47:205–210.CrossRefGoogle Scholar
  13. 13.
    Harrison S, Kakade M, Varadarajula S, Parden J, Morgan D, Christein J. Characteristics and outcomes of patients undergoing debridement of pancreatic necrosis. J Gastrointest Surg. 2010;14:245–251.CrossRefGoogle Scholar
  14. 14.
    van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141:1254–1263.CrossRefGoogle Scholar
  15. 15.
    Petrov MS, Shanbhag S, Chakraborty M, Phillips AR, Windsor JA. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology. 2010;139:813–820.CrossRefGoogle Scholar
  16. 16.
    Windsor JA. Search for prognostic markers for acute pancreatitis. Lancet. 2000;355:1924–1925.CrossRefGoogle Scholar
  17. 17.
    Wang AJ, Xu S, Hong JB, et al. The comparison of different clinical scoring systems for predicting prognosis in acute pancreatitis based on the revised Atlanta classification. Zhonghua Nei Ke Za Zhi. 2013;52:668–671.Google Scholar
  18. 18.
    Larvin M, McMahon MJ. APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet. 1989;2:201–205.CrossRefGoogle Scholar
  19. 19.
    Gurusamy KS, Farouk M, Tweedie JH. UK guidelines for management of acute pancreatitis: is it time to change? Gut. 2005;54:1344–1345.CrossRefGoogle Scholar
  20. 20.
    Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–2400.CrossRefGoogle Scholar
  21. 21.
    Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med. 1996;22:707–710.CrossRefGoogle Scholar
  22. 22.
    Craig DG, Reid TW, Wright EC, et al. The sequential organ failure assessment (SOFA) score is prognostically superior to the model for end-stage liver disease (MELD) and MELD variants following paracetamol (acetaminophen) overdose. Aliment Pharmacol Ther. 2012;35:705–713.CrossRefGoogle Scholar
  23. 23.
    Namendys-Silva SA, Texcocano-Becerra J, Herrera-Gomez A. Application of the sequential organ failure assessment (SOFA) score to patients with cancer admitted to the intensive care unit. Am J Hosp Palliat Care. 2009;26:341–346.CrossRefGoogle Scholar
  24. 24.
    Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg. 2006;93:738–744.CrossRefGoogle Scholar
  25. 25.
    Singh VK, Wu BU, Bollen TL, et al. Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clin Gastroenterol Hepatol. 2009;7:1247–1251.CrossRefGoogle Scholar
  26. 26.
    Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139:69–81.Google Scholar
  27. 27.
    Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57:1698–1703.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Man Li
    • 1
  • Xiao-kang Xing
    • 1
  • Zhi-hua Lu
    • 1
  • Feng Guo
    • 1
    Email author
  • Wei Su
    • 1
  • Yong-jun Lin
    • 1
  • Dong-hai Wang
    • 1
  1. 1.Department of Critical Care MedicineZhejiang University School of Medicine Sir Run Run Shaw HospitalHangzhouChina

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