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Background: Pancreatitis can lead to serious complications with severe morbidity and mortality. So an early, quick and accurate scoring system is necessary to stratify the patients according to their severity so as to enable early initiation of required management and care. Scoring system commonly used have some drawbacks. This study aimed to compare bedside index for severity in acute pancreatitis (BISAP) and Ranson’s score to predict severe acute pancreatitis and establish the validity of a simple and accurate clinical scoring system for stratifying patients.Methods: This is a prospective comparative study on 100 patients diagnosed with acute pancreatitis admitted in department of general surgery. Parameters included in the BISAP and Ranson’s criteria were studied at the time of admission and after 48 hours. Result of these two were compared with that of revised Atlanta classification.Results: As per the BISAP score, the sensitivity and specificity were 95.8 % (95% CI, 76.8-99.8), 94.7 % (95% CI, 86.3-98.3) whereas positive likelihood ratio, negative likelihood ratio 18.21 (95% CI, 6.9-47.44), 0.04 (95% CI, 0.01-0.30) and accuracy was 95 % (95% CI, 88.72%-98.36%). On using Ranson’s score, the sensitivity and specificity were 91.6 (95% CI, 71.5-98.5) and 89.4 (95% CI, 79.8-95) with a positive predictive value 8.71 (95% CI, 4.47-18.96) and negative predictive value of 0.09 (95% CI, 0.02-0.35) and accuracy of 90% (95% CI, 82.38%-95.10%)..Conclusions: BISAP score outperformed Ranson’s score in terms of Sensitivity and specificity of prediction of severe pancreatitis. The authors recommend inclusion of BISAP Scoring system in standard treatment protocol of management of acute pancreatitis.
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Background: The best model to determine the postoperative complications must be simple and easily applicable to the majority of surgical patients. The complications and their incidence should be precisely defined and estimated. The model should also have a low threshold to identify them. The ASA classification was initially intended as a means to stratify a patient’s systemic illness but not post-operative risk. Although the ASA classification has proved to be a predictive pre-operative risk factor in mortality models, its subjective nature and inconsistent scoring between providers make it less than ideal for performing evidence-based post-operative risk calculation. Aim of the study: The aim of the study was to determine the applicability of the Surgical Apgar Score in post-operative risk stratification for morbidity and mortality during the 30 days postlaparotomy. Materials and methods: In this study, 152 in-patient Visiting Government Stanley Medical College General Hospital from March 2017 to April 2018 had been studied. Patients undergone laparotomy at Department of General Surgery, Government Stanley Medical College were managed by a tier of doctors from anesthetic technicians, medical officer interns, medical officers, postgraduates in general surgery and anesthesiology and their consultants. Interns and postgraduates in general surgery provided the pre and postoperative care and participate in general surgical procedures whenever indicated. Anesthesiologists apart from providing anesthesia during surgery extended their care in the intensive care unit. Parimala, G. Venkatesh, P. Vijayaraghavan. Utility of surgical APGAR score in predicting post-operative morbidity and mortality in patients undergoing laparotomy – A prospective study. IAIM, 2019; 6(6): 67-74. Page 68 Results: 132 patients were operated as an emergency and only 20 patients were operated selectively. 86.8% of the surgeries were emergency laparotomies and only 13.2% of the surgeries were elective. This showed our efficient functioning and round the clock services of our emergency theatres. The most common causes in descending order include penetrating injury, intestinal obstruction, peritonitis, perforated duodenal ulcer, blunt injury abdomen, intra-abdominal abscess, hydatid cyst, obstructed hernia, mesenteric ischemia, cholecystitis. A significantly higher complication was noted among female patients at 63.2% compared to male patients at 33.3%. 43.9% of the postoperative complications occurred in emergency setting whereas only 20% of the complications occurred in the elective setting. When the complications were compared with the duration of surgery, those surgeries that lasted more than 120 minutes had a higher complication rate of 68.6% whereas surgeries with a shorter duration only had a complication rate of 26.7%. Conclusion: Surgical Apgar Score is very effective in identifying high-risk patients who are capable of developing significant complications following laparotomy within the first 30 postoperative days. This identification of high-risk patients helps us in the judicious use of healthcare resources towards the proper monitoring and follow up of these patients.
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Objective To evaluate the six scoring systems and four laboratory tests,including pancreatitis outcome prediction (POP),Ranson score,bedside index for severity in acute pancreatitis (BISAP),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),systemic inflammatory response syndrome (SIRS),and Glasgow score as well as four laboratory tests including C-reactive protein (CRP),hematocrit (HCT),blood urea nitrogen (BUN) and serum creatinine (Scr) in the prognostic assessment of severe acute pancreatitis (SAP).Methods From January 2016 to December 2017,at Sir Run Run Shaw Hospital,151 SAP patients who met the enrollment criteria were retrospectively analyzed.According to the time from onset to treatment,the patients were divided into less than three days group (n=102) and over three days group (n=49).The evaluation of six scoring systems and four laboratory tests,including CRP,HCT,BUN and Scr at 0,24 and 48 h after hospitalization in the prognostic assessment of SAP patients was measured by receiver-operating characteristic (ROC) curve.Results The Ranson score had the highest area under curve (AUC) value (0.916) in the evaluation of the prognosis of SAP patients less than three days group followed by BISAP,APACHE Ⅱ,Glasgow and POP score,and their AUC values were 0.832,0.823,0.793,and 0.787,respectively,all of them were statistically significant in the prognostic assessment of SAP patients in less than three days group (all P＜0.05).There were statistically significant of BISAP and APACHE Ⅱ scores in the prognostic evaluation of SAP patients in over three days group (both P＜0.05),and the AUC values were 0.751 and 0.735,respectively,which were less than those of SAP patients in less than three days group.There were statistical significance of BUN and Scr at 24 and 48 h after hospitalization in the prognostic assessment of SAP patients in less than three days group (all P＜0.05),and the AUC values were 0.856,0.853 and 0.793,0.874,respectively.There were statistical significance of BUN at 0,24,48 h and Scr at 48 h after hospitalization in the prognostic assessment of SAP patients in over three days group (all P＜0.05),and the AUC value was 0.709,0.754,0.742 and 0.716,respectively.Conclusions Ranson,POP and Glascow score systems are only suitable for patients with SAP less than three days.APACHE Ⅱ,BISAP score systems,BUN and Scr can be used to evaluate patients with SAP over three days,but are more suitable for patients with SAP less than three days group.
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Background: Acute pancreatitis is a common condition with wide clinical variation, ranging from mild self-limiting pancreatic inflammation to extensive pancreatic necrosis with life-threatening consequences. The present study aimed to assess the clinical profile of acute pancreatitis in Malwa region of Punjab where there increased prevalence of alcoholism and gall stone disease and to assess the efficacy of Ranson’s score and Balthazar Computed tomography severity index (CTSI) in predicting the prognosis. Materials and methods: 50 patients with proven acute pancreatitis were included and data was collected to study their clinical, laboratory and radiologic profile to obtain prognostic indices Ranson’s score and CTSI which were then compared with outcome. Results: Mean age recorded was 43.40 ±12.004 years with a range of 19-64 years and male to female ratio 2.12:1. 62% of patients had alcohol induced pancreatitis and 32% had gall stone pancreatitis. Observed morbidity rate was 44% and mortality rate was 6%. Most common complications encountered were pleural effusion (18%), Hypocalcemia (20%) and sterile pancreatic necrosis (20%). 18 patients had Ranson’s score more than 3, whereas 11 patients had CTSI more than 7 indicating severe acute pancreatitis. On correlation Ranson’s score was found to be more sensitive while CTSI was more specific for an adverse outcome. Conclusion: Severe acute pancreatitis remains a significant cause of morbidity and mortality due to increased prevalence both alcoholism and gall stone disease in Malwa region of Punjab. In our setup Ranson’s score and CTSI when used in combination showed improved sensitivity for detection severe acute pancreatitis.
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Objective To explore the etiological factors,clinical characteristic and diagnosis of nonacute biliary pancreatitis (NABP) and acute biliary pancreatitis (ABP).Methods The Clinical data of 152 patients with NABP and 206 patients with ABP from January 2004 to December 2014 in the Hepatobiliary Surgery Department of Jinshan Branch of the Sixth People's Hospital of Shanghai were analyzed retrospectively.Results There were no statistically significant differences in terms of the Ranson score,blood amylase and C reactive protein (CRP) between two groups (P ＞ 0.05).The incidences rate of hepatic insufficiency,renal insufficiency and encephalopathy were 35.5％ (54/152),25.6％ (39/152) and 8.5％ (13/152) in the NABP group,and 25.7％(53/206),12.1％(25/206) and 3.3％(7/206) in the ABP group,with significant difference between the two groups (x2 =4.01,10.89,4.41;P ＜ 0.05).Conclusion The key to reduce the complications and improve the cure rate is to make clear the etiology of NABP and ABP and to take active and effective treatment for the cause of the disease.
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Objective To explore the four criteria,including bedside index for severity in acute pancreatitis(BISAP),Ranson score,modified CT severity index(MCTSI) and acute physiology and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) in assessment of severity and prognosis of hyperlipidemic acute pancreatitis.Methods A total of 326 patients with hyperlipidemic acute pancreatitis were studied retrospectively from August 2006 to July 2015.The discrepancy of the four criteria in assessment of severity and prognosis of hyperlipidemic acute pancreatitis was compared with chi-square test and receiver operating characteristic curve.Results The incidences of moderately severe acute pancreatitis and severe acute pancreatitis,local complications and mortality of patients with BISAP score ≥3,Ranson score ≥3,APACHE Ⅱ score≥8 and MCTSI score≥4 were significantly higher than BISAP score ＜ 3,Ranson score ＜ 3,APACHE Ⅱ score ＜ 8 and MCTSI ＜ 4 respectively (all P ＜ 0.05).As far as severity was concerned,the sensitivity and AUC of APACHE Ⅱ were 57％ and 0.814,which were higher than the other systems.The second most sensitive criterion was BISAP.In assessment of local complications,the sensitivity and AUC of MCTSI were 68％ and 0.791,which were higher than the other three.The most sensitive criterion to predict mortality was BISAP with sensitivity 89％ and AUC 0.867,which was followed by APACHE Ⅱ.Conclusions All four criteria can be used to determine the severity,local complications and mortality.Generally,BISAP is simple and easy to practice,and better than the other three.
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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.
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Objective To approach the significance of procalcitonin(PCT)in judgment of the degree of severity in patients with acute pancreatitis(AP). Methods A prospective method was conducted in the study. Ninety-eight patients with AP admitted from April 2013 to December 2013 in the First Affiliated Hospital of Zhengzhou University were enrolled. They were divided into mild AP(MAP,48 cases)and severe AP(SAP,50 cases)groups, biliary AP(58 cases)and non biliary AP(40 cases)groups,and biliary SAP and biliary MAP groups,non biliary SAP and non biliary MAP groups. The venous blood levels of PCT on the first day and second day after admission were assayed for all the patients,and the correlations between PCT levels on the two time points respectively and each of the following items were calculated:Ranson score,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,CT grade,number of organ dysfunction,intensive care unit(ICU)time of stay and total time of hospitalization. Results On the second day after admission,the PCT levels in groups different in etiology and groups different in severity were all elevated and higher than those on the first day,the level in SAP group being significantly higher than that of MAP group〔3.723(2.538,9.023)vs. 0.282(0.166,1.348),P0.05〕,the level in biliary SAP group being higher than that in biliary MAP group〔4.023(3.273,10.015)vs. 0.305 (0.244,1.413),P<0.01〕,and the level in non biliary SAP group being higher than that in non biliary MAP group〔3.624(2.454,8.993)vs. 0.256(0.144,1.137),P<0.01〕. The correlations between PCT levels on the first day and second day after admission and each of the following items were respectively as follows:the correlations with Ranson score〔relative risk (RR1)=0.643,P1=0.001,95% confidence interval(95%CI1):0.435-1.596;RR2=0.762, P2=0.001,95%CI2:0.692-1.541〕,APACHE Ⅱ score(RR1=0.543,P1=0.009,95%CI1:0.842-1.512;RR2=0.672,P2=0.001,95%CI2:0.747-1.234)and CT grade(RR1=0.231,P1=0.048,95%CI1:0.596-1.412;RR2=0.256,P2=0.032,95%CI2:0.702-1.324)were all positive;the higher the number of organ dysfunction,the higher the level of PCT(RR1=0.321,P1=0.023,95%CI1:0.763-2.588;RR2=0.389,P1=0.020,95%CI2:0.683-1.742);the level of PCT had relatively favorable correlation with ICU time of stay(RR1=0.423,P1=0.019,95%CI1:0.779-1.459;RR2=0.453,P2=0.010,95%CI2:0.684-1.853),but there was no correlation between the level and the total time of hospitalization(RR1=0.004,P1=0.067,95%CI1:0.864-2.071;RR2=0.009,P2=0.078,95%CI2:0.645-1.376). Conclusion The level of PCT can be used in judgment of the degree of severity of the patients with AP,not only it can be applied in patients biliary in origin,but also can be used in patients non biliary in origin.
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Objective To analyze the clinical features of acute hyperlipidemic panereatitis,and to investigate the therapeutic strategies.Methods In this retrospective study,44 patients with hyperlipidemic pancreatitis admitted to our hospital from January 2003 to December 2007 were enrolled,60 patients with acute pancreatitis of other etiologies were enrolled as the control group.Results The proportions of patients with overweight or obesity,hyperglycemia,fatty liver and hypertension were 81.8%,59.1%,54.5% and 68.2%,respectively;these were significantly higher than those in control group,which were 16.7%,16.7 %,13.3 % and 23.3 %,respectively (P＜0.05 or＜0.01).The proportion of patients with lithiasis was lower in HLP group than that in control group (13.6% vs 60.0%,P＜0.05).There was no difference in the proportions of patients with chronic alcoholism between two groups.The Ranson score,CTSI,complications in HLP group were 3.15±0.07,4.46±2.58 and 3.2±1.7,respectively;these parameters were significantly higher than those in control group,which were 1.62±0.22,2.62±1.90 and 0.9±1.2 (P＜0.05 or ＜ 0.01 ).The level of serum amylase in HLP group was 580±222 mmol/L,which was significantly lower than that of control group (1361±472 mmol/L,P ＜ 0.01 ).The triglyceride (TG) level was linearly correlated with Ranson score in HLP group ( r = 0.77,P ＜ 0.05 ),but there was no linear correlation between TG level and Ranson score in the control group.Conclusions There was a close relationship between HLP and metabolic syndrome.Serum TG was positively correlated with the severity of HLP.
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Objective To evaluate the modified early warning score (MEWS) system in the assessment of the severity and prognosis in acute pancreatitis (AP). Method Ninety two AP patients had been recruited from the Department of Emergency Medicine during November, 2007 to May, 2008. All patients fulfilled at least 2 of the three criteria of American AP clinical guideline, (1) typical abdominal pain; (2) serum amylase level ≥3times of upper normal limit; (3) typical ultrasound or CT findings for AP. Patients with cardiac, pulmonary, hepatic , renal insufficiency or other comorbidities were ruled out. Each patient was evaluated MEWS at day 1,2, and 3 after admission, and subsequently stratified into two groups: high risk group with MEWS ≥4 and moderate risk group with MEWS < 4. The clinical course, end organ failure, and mortality rate was compared between two groups. Other parameters including Ranson score, APACHE Ⅱ score were also obtained. Spearman correlation,group student t test, or Chi square tests were used. Results High risk group has significant prolonged clinical course ( P < 0.05 ) , higher end organ failure rate (P < 0.01) , compared to low risk group. Patients who can not achieve MEWS improvements after interventions have the highest mortality rate (P < 0.01). The MEWS positively correlated with Ranson and APACHE Ⅱ scores ( r = 0.486, and 0.583, respectively, P <0.05). Conclusions MEWS is a valid and simple tool to evaluate severity and prognosis of AP in early stage.
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Objective To evaluate the relationship between hypertriglyceridemia and acute pancreatitis.Methods Data was analyzed from 41 patients with acute pancreatits from Apr.1998 to Oct.2000 in our hospital.Of the 13 patients(GroupⅠ) with plasma TG level being higher than 11.3 mmol/L, 8 accompanied with gallstone(61.5%)and 5 without gallstone(38.5%)of the 28 patients (GroupⅡ) with plasma TG level being lower than 11.3 mmol/L,19 accompanied with gallstone(47.3%)and 9 without gallstone(52.7%)RANSON score,morbidity of complications and the level of ALT and AST were compared between two groaps.The correlation between TG and RANSON score was analysed.Results There were significant difference between the two groups on RANSON score,morbidity of complications and level of ALT and AST(P0.05).Conclusion There is an close relationship between hypertriglyceridemia and acute pancreatitis,the high level of plasma TG plags a key a role in acute pancreatitis,patients with acute pancreatitis with hypertriglyceridemia are more likely to have higher morbidity of complications and liver function aggravating.