Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis
Background. Multifactorial scorings, radiological scores, and biochemical markers may help in early prediction of severity, pancreatic necrosis, and mortality in patients with acute pancreatitis (AP). Methods. BISAP, APACHE-II, MOSS, and SIRS scores were calculated using data within 24？hrs of admission, whereas Ranson and Glasgow scores after 48？hrs of admission; CTSI was calculated on day 4 whereas IL-6 and CRP values at end of study. Predictive accuracy of scoring systems, sensitivity, specificity, and positive and negative predictive values of various markers in prediction of severe acute pancreatitis, organ failure, pancreatic necrosis, admission to intensive care units and mortality were calculated. Results. Of 72 patients, 31 patients had organ failure and local complication classified as severe acute pancreatitis, 17 had pancreatic necrosis, and 9 died (12.5%). Area under curves for Ranson, Glasgow, MOSS, SIRS, APACHE-II, BISAP, CTSI, IL-6, and CRP in predicting SAP were 0.85, 0.75, 0.73, 0.73, 0.88, 0.80, 0.90, and 0.91, respectively, for pancreatic necrosis 0.70, 0.64, 0.61, 0.61, 0.68, 0.61, 0.75, 0.86, and 0.90, respectively, and for mortality 0.84, 0.83, 0.77, 0.76, 0.86, 0.83, 0.57, 0.80, and 0.75, respectively. Conclusion. CRP and IL-6 have shown a promising result in early detection of severity and pancreatic necrosis whereas APACHE-II and Ranson score in predicting AP related mortality in this study. 1. Introduction Acute pancreatitis (AP) is defined as an inflammatory process of the pancreas with possible peripancreatic tissue and multiorgan involvement inducing multiorgan dysfunction syndrome (MODS) with an increased mortality rate [1]. The incidence of acute pancreatitis per 100,000 population ranges from 5 to 80 cases per year, with the highest incidence rates being seen in Finland and the USA [2]. According to the Atlanta Classification, severe acute pancreatitis (SAP) is defined as an AP associated with local and/or systemic complications. Atlanta classification is a clinically based classification defining AP, severity, and complications. Development of organ dysfunction within 72？h of symptom onset is defined as an early severe acute pancreatitis (ESAP). Early severe acute pancreatitis is characterized by a short course, progressive MODS, early hypoxemia, increased incidence of necrosis, infection, and abdominal compartment syndrome (ACS) [3]. Multiorgan dysfunction syndrome, the extent of pancreatic necrosis, infection, and sepsis are the major determinants of mortality in AP [4]. Pancreatic necrosis is considered as a potential
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