ABSTRACT
Objective To compare the clinic significance of four clinical scoring systems in evaluating prognosis of acute pancreatitis: bedside index for severity in acute pancreatitis(BISAP), acute physiology and chronic health evaluation (APACHEⅡ), Ranson’s scoring system, computed tomography severity index (CTSI) in AP. Methods Patients visited our clinic with AP (n=114) in recent 2 years were retrospectively analyzed. BISAP and APACHEⅡscores were obtained at 24 hours after admission; Ranson ’s score was obtained at 48 hours after admission and CTSI are obtained was obtained at 72 hours after admission. Results of four scoring system were compared under different causes and different severity of the dis?ease. Correlation between BISAP score and the other three scores were analyzed and the predicative value of all four scoring systems for severity of AP and death were also compared. Results The mean values of four scoring systems show no signifi?cant difference in AP patients with different etiology (P>0.05). The BISAP score is positively correlated with APACHE-Ⅱ, Ranson ’s score and CTSI score (P<0.01). The four scoring systems all present good predictive value on the severity of AP and death (P<0.01). Conclusion The four scoring systems can all be applied to grading and prognosis for AP of various causes. BISAP is a simple, prompt, economical scoring system in clinical practice.
ABSTRACT
Objective To investigate the relationship between values of blood calcium, serum urea nitrogen (BUN), D-dimer, C-reactive protein (CRP), fibrinogen and amylase with the severity of the disease in patients with acute pancreatitis (AP). Methods There were 70 patients with mild AP (MAP group), 18 patients with moderate AP (MSAP group), 26 pa?tients with severe acute pancreatitis (SAP group) in 114 AP patients. The laboratory indexes were compared between these groups. The correlation between indexes and the acute physiology and chronic health evaluation systemⅡ (APACHE Ⅱ) score was analysed. The diagnostic sensitivity of SAP using CRP, D-dimer and fibrinogen was analysed by ROC curves. Re?sults Compared with MAP group, values of BUN, CRP, D-dimer,fibrinogen and APACHEⅡscore were significantly increased in SAP group (P<0.05), but serum calcium level was significantly decreased (P<0.05). The APACHEⅡscore were significantly higher in SAP group than that of MSAP group (P<0.05). There were no significant differences in level of amylases between three groups. There was a positive correlation between APACHEⅡscore, CRP, D-dimer and fibrinogen (r=0.407, 0.404 and 0.245, P<0.05). There was a negative correlation between APACHEⅡscore and serum calcium level (r=-0.333, P<0.05). The area under the ROC curve showed a maximum CRP curve for diagnosing SAP 0.752 (95%CI=0.644-0.860). The cut-off value was 74.45 mg/L. The sensitivity was 86.4%. And the specificity was 68.2%. Conclusion Combining with monitoring BUN, blood coagulation index, CRP, serum calcium level and other laboratory parameters was useful to overall evaluate AP patients and improve the prognosis.