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Predictive Scoring Systems in Acute Pancreatitis

  • Kavya M. Reddy
  • Bechien U. WuEmail author
Chapter
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Abstract

Acute pancreatitis is a disease of increasing annual incidence and one that produces significant morbidity and mortality. The ability to predict which patients are at risk for complications is critical in ensuring appropriate management and development of prevention strategies. For this reason, many scores have been developed to predict the severity of acute pancreatitis. Most of the scores incorporate a variety of physiologic, laboratory, and radiological parameters. This chapter will summarize and compare the current prediction models for severe acute pancreatitis as well as measurement of specific routine laboratory tests. The relative advantages and disadvantages of each of these systems will be highlighted. The clinical scoring systems that will be discussed include the Ranson’s score, the Glasgow criteria (also known as the Imrie score), Acute Physiology and Chronic Health Examination (APACHE)-II, Systemic Inflammatory Response Syndrome (SIRS), Pancreatitis Outcome Prediction (POP), Bedside Index for Severity in Acute Pancreatitis (BISAP), the revised Japanese severity score (JSS), and Harmless Acute Pancreatitis Score (HAPS). Particular emphasis will be devoted to the application of these various scoring systems in the routine care of patients with acute pancreatitis.

Keywords

Acute Pancreatitis Positive Predictive Value Negative Predictive Value Blood Urea Nitrogen Systemic Inflammatory Response Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Fagenholz PJ, Castillo CF, Harris NS, Pelletier AJ, Camargo Jr CA. Increasing United States hospital admissions for acute pancreatitis, 1988-2003. Ann Epidemiol. 2007;17:491–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med. 2006;354:2142–50.PubMedCrossRefGoogle Scholar
  3. 3.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis—2012; revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.PubMedCrossRefGoogle Scholar
  4. 4.
    Harrison DA, D’Amico G, Singer M. The Pancreatitis Outcome Prediction (POP) score: a new prognostic index for patients with severe acute pancreatitis. Crit Care Med. 2007;35(7):1703–8. PubMed PMID: 17522578.PubMedCrossRefGoogle Scholar
  5. 5.
    Ranson JHC, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Surg Gynecol Obstet. 1974;139:69.PubMedGoogle Scholar
  6. 6.
    De Bernardinis M, Violi V, Roncoroni L, Boselli AS, Giunta A, Peracchia A. Discriminant power and information content of Ranson’s prognostic signs in acute pancreatitis: a meta-analytic study. Crit Care Med. 1999;27(10):2272.PubMedCrossRefGoogle Scholar
  7. 7.
    Forsmark CE, Baillie J, AGA Institute Clinical Practice and Economics Committee, AGA Institute Governing Board. AGA Institute technical review on acute pancreatitis. Gastroenterology. 2007;132(5):2022–44. Review. PubMed PMID: 17484894.PubMedCrossRefGoogle Scholar
  8. 8.
    Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson’s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010;105:435–41.PubMedCrossRefGoogle Scholar
  9. 9.
    Eachempati SR, Hydo LJ, Barie PS. Severity scoring for prognostication in patients with severe acute pancreatitis: comparative analysis of the Ranson score and the APACHE III score. Arch Surg. 2002;137(6):730–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Steinberg WM. Predictors of severity of acute pancreatitis. Gastroenterol Clin North Am. 1990;19(4):849–61.PubMedGoogle Scholar
  11. 11.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.PubMedCrossRefGoogle Scholar
  12. 12.
    Wilson C, Heath DI, Imrie CW. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg. 1990;77:1260–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Chatzicostas C, Roussomoustakaki M, Vlachonikolis IG, Notas G, Mouzas I, Samonakis D, et al. Comparison of Ranson, APACHE II and APACHE III scoring systems in acute pancreatitis. Pancreas. 2002;25:331–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Fan ST, Lai EC, Mok FP, Lo CM, Zheng SS, Wong J. Prediction of the severity of acute pancreatitis. Am J Surg. 1993;166(3):262–8; discussion 9.PubMedCrossRefGoogle Scholar
  15. 15.
    Larvin M, McMahon MJ. APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet. 1989;2(8656):201–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Mason JM, Babu BI, Bagul A, Siriwardena AK. The performance of organ dysfunction scores for the early prediction and management of severity in acute pancreatitis: an exploratory phase diagnostic study. Pancreas. 2010;39(7):1104–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Johnson CD, Toh SK, Campbell MJ. Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis. Pancreatology. 2004;4:1.PubMedCrossRefGoogle Scholar
  18. 18.
    Papachristou GI, Papachristou DJ, Avula H, Slivka A, Whitcomb DC. Obesity increases the severity of acute pancreatitis: performance of APACHE-O score and correlation with the inflammatory response. Pancreatology. 2006;6(4):279–85.PubMedCrossRefGoogle Scholar
  19. 19.
    Williams M, Simms HH. Prognostic usefulness of scoring systems in critically ill patients with severe acute pancreatitis. Crit Care Med. 1999;27:901.PubMedCrossRefGoogle Scholar
  20. 20.
    Blamey SL, Imrie CW, O’Neill J, Gilmour WH, Carter DC. Prognostic factors in acute pancreatitis. Gut. 1984;25:1340–6.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Simoes M, Alves P, Esperto H, Canha C, Meira E, Ferreira E. Predicting acute pancreatitis severity: comparison of prognostic scores. Gastroenterol Res. 2011;4(5):216–22.Google Scholar
  22. 22.
    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;57:1698–703.PubMedCrossRefGoogle Scholar
  23. 23.
    Singh VK, Wu BU, Bollen TL, Repas K, Maurer R, Johannes RS, et al. A prospective evaluation of the Bedside Index for Severity in Acute Pancreatitis score in assessing mortality and intermediate markers of severity in acute pancreatitis. Am J Gastroenterol. 2009;104:966–71.PubMedCrossRefGoogle Scholar
  24. 24.
    Villacís X, Calle P, Patiño J, Calle G. [Score BISAP validation as a prognostic system in acute pancreatitis]. Rev Gastroenterol Peru. 2011;31(3):230–5. Spanish. PubMed PMID: 22086317.PubMedGoogle Scholar
  25. 25.
    Buter A, Imrie CW, Carter CR, Evans S, McKay CJ. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg. 2002;89:298–302.PubMedCrossRefGoogle Scholar
  26. 26.
    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;93:738–44.PubMedCrossRefGoogle Scholar
  27. 27.
    Singh VK, Wu BU, Bollen TL, Repas K, Maurer R, Mortele KJ, et al. Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clin Gastroenterol Hepatol. 2009;7:1247–51.PubMedCrossRefGoogle Scholar
  28. 28.
    Bone RC, Sibbald WJ, Sprung CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest. 1992;101:1481–3.PubMedCrossRefGoogle Scholar
  29. 29.
    Lankisch PG, Weber-Dany B, Hebel K, Maisonneuve P, Lowenfels AB. The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratification of nonsevere disease. Clin Gastroenterol Hepatol. 2009;7:702.PubMedCrossRefGoogle Scholar
  30. 30.
    Oskarsson V, Mehrabi M, Orsini N, Hammarqvist F, Segersvärd R, Andrén-Sandberg A, et al. Validation of the harmless acute pancreatitis score in predicting nonsevere course of acute pancreatitis. Pancreatology. 2011;11(5):464–8. doi: 10.1159/000331502. Epub 2011 Sep 29. PubMed PMID:21968430.PubMedCrossRefGoogle Scholar
  31. 31.
    Brown A, James-Stevenson T, Dyson T, Grunkenmeier D. The panc 3 score: a rapid and accurate test for predicting severity on presentation in acute pancreatitis. J Clin Gastroenterol. 2007;41(9):855–8. PubMed PMID: 17881932.PubMedCrossRefGoogle Scholar
  32. 32.
    Hamada T, Yasunaga H, Nakai Y, Isayama H, Horiguchi H, Fushimi K, Koike K. Japanese severity score for acute pancreatitis well predicts in-hospital mortality: a nationwide survey of 17,901 cases. J Gastroenterol. 2013;48(12):1384–91. doi: 10.1007/s00535-013-0765-6. Epub 2013 Feb 19. PubMed PMID: 23420576.PubMedCrossRefGoogle Scholar
  33. 33.
    Mounzer R, Langmead CJ, Wu BU, Evans AC, Bishehsari F, Muddana V, et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology. 2012;142(7):1476–82. PubMed PMID: 22425589.PubMedCrossRefGoogle Scholar
  34. 34.
    Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174:331.PubMedCrossRefGoogle Scholar
  35. 35.
    Baillargeon JD, Orav J, Ramagopal V, Tenner SM, Banks PA. Hemoconcentration as an early risk factor for necrotizing pancreatitis. Am J Gastroenterol. 1998;93:2130–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Brown A, Orav J, Banks PA. Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis. Pancreas. 2000;20:367–72.PubMedCrossRefGoogle Scholar
  37. 37.
    Remes-Troche JM, Duarte-Rojo A, Morales G, Robles-Díaz G. Hemoconcentration is a poor predictor of severity in acute pancreatitis. World J Gastroenterol. 2005;11:7018–23.PubMedGoogle Scholar
  38. 38.
    Lankisch PG, Mahlke R, Blum T, Bruns A, Bruns D, Maisonneuve P, et al. Hemoconcentration: an early marker of severe and/or necrotizing pancreatitis? A critical appraisal. Am J Gastroenterol. 2001;96:2081–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Gardner TB, Olenec CA, Chertoff JD, Mackenzie TA, Robertson DJ. Hemoconcentration and pancreatic necrosis: further defining the relationship. Pancreas. 2006;33:169–73.PubMedCrossRefGoogle Scholar
  40. 40.
    Muddana V, Whitcomb DC, Khalid A, Slivka A, Papachristou GI. Elevated serum creatinine as a marker of pancreatic necrosis in acute pancreatitis. Am J Gastroenterol. 2009;104:164–70.PubMedCrossRefGoogle Scholar
  41. 41.
    Wu BU, Johannes RS, Sun X, Conwell DL, Banks PA. Early changes in blood urea nitrogen predict mortality in acute pancreatitis. Gastroenterology. 2009;137:129–35.PubMedCrossRefGoogle Scholar
  42. 42.
    Wu B, Bakker OJ, Papchristou GI, Repas K, Besselink MG, van Santvoort HC, et al. Prognostic value of blood urea nitrogen (BUN) in the early assessment of acute pancreatitis: an international study [abstract 475p]. Gastroenterology. 2010;138 Suppl 1:S-66.Google Scholar
  43. 43.
    Papachristou GI, Whitcomb DC. Inflammatory markers of disease severity in acute pancreatitis. Clin Lab Med. 2005;25:17–37.PubMedCrossRefGoogle Scholar
  44. 44.
    Neoptolemos JP, Kemppainen EA, Mayer JM, Fitzpatrick JM, Raraty MG, Slavin J, et al. Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. Lancet. 2000;355:1955–60.PubMedCrossRefGoogle Scholar
  45. 45.
    American Gastroenterological Association (AGA) Institute on “Management of Acute Pancreatits” Clinical Practice and Economics Committee, AGA Institute Governing Board. AGA Institute medical position statement on acute pancreatitis. Gastroenterology. 2007;132(5):2019–21. PubMed PMID: 17484893.CrossRefGoogle Scholar
  46. 46.
    De-Madaria E, Banks PA, Moya-Hoyo N, Wu BU, Rey-Riveiro M, Acevedo-Piedra NG, et al. Early factors associated with fluid sequestration and outcomes of acute pancreatitis. Clin Gastroenterol Hepatol. 2013. doi: 10.1016/j.cgh.2013.10.017.

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Internal MedicineKaiser Permanente Los Angeles Medical CenterLos AngelesUSA
  2. 2.Department of Gastroenterology, Center for Pancreatic CareKaiser Permanente Los Angeles Medical CenterLos AngelesUSA

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