Comparision of the scoring systems to predict clinical outcomes in older adults with biliary pancreatitis: a cross-sectional study

Year 2022, Volume: 4 Issue: 4, 394 - 400, 22.10.2022

Osman İnan , Muhammed Fatih Acehan , Enes Seyda Şahiner , Meryem Aslan , Emin Altıparmak , İhsan Ateş

https://doi.org/10.38053/acmj.1150437

Abstract

Aim: The issue of which scoring system is appropriate in older adults patients with acute biliary pancreatitis is an ongoing debate. We aimed to compare the efficiency of four existing scoring systems in predicting clinical outcomes in the elderly with acute biliary pancreatitis.
Material and Method: The study included patients aged 60 years and older with a diagnosis of acute biliary pancreatitis. Clinical findings, routine laboratory examinations, and imaging findings were retrospectively accessed through the hospital information system and reviewed. Then, the efficacy of Ranson, Bedside Index of Severity in Acute Pancreatitis (BISAP), Glasgow-Imrie, and Acute Physiology and Chronic Health Evaluation (APACHE) II scoring systems in predicting mortality, severity, organ failure, complications, intensive care unit (ICU) admission, and prolonged hospital stay (PHS) were compared.
Results: The Ranson score was compared with three other existing scoring systems in primary and secondary outcomes in 364 eligible patients. The area under the curve (AUC) values of the Ranson, BISAP, Glasgow, and APACHE II scores were 0.787 (95% CI: 0.649-0.925), 0.856 (95% CI: 0.784-0.929), 0.908 (95% CI: 0.854-0.961), and 0.836 (95% CI: 0.702-0.971) for mortality. Although the AUC of the Ranson score for mortality was lower than that of the other scores, no significant difference was found in pairwise comparisons with the other three scores (p>0.05 for all).
Conclusion: The Ranson scoring system was the weakest among the assessed scoring systems in predicting clinical outcomes in older adults with biliary pancreatitis.

Keywords

Acute pancreatitis, elderly, scoring methods, Apache II, roc curve

References

• Machicado JD, Yadav D. Epidemiology of recurrent acute and chronic pancreatitis: similarities and differences. Dig Dis Sci 2017; 62: 1683-91.
• Peery AF, Crockett SD, Barritt AS, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology 2015; 149: 1731-41.
• Pendharkar SA, Salt K, Plank LD, Windsor JA, Petrov MS. Quality of life after acute pancreatitis: a systematic review and meta-analysis. Pancreas 2014; 43: 1194-200.
• Hazra N, Gulliford M. Evaluating pancreatitis in primary care: a population-based cohort study. Br J Gen Pract 2014; 64: e295-301.
• Lindkvist B, Appelros S, Manjer J, Borgström A. Trends in incidence of acute pancreatitis in a Swedish population: is there really an increase? Clin Gastroenterol Hepatol 2004; 2: 831-7.
• Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet; 381: 752-62.
• Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: A systematic review. Pancreas 2006; 33: 323-30.
• Banks PA, Bollen TL, Dervenis C, et al. Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 20131; 62: 102-11.
• Wu BU, Banks PA. Clinical management of patients with acute pancreatitis. Gastroenterology 2013; 144: 1272–81.
• Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis. Gastroenterology 2019; 156: 2008–23
• Singh VK, Wu BU, Bollen TL, 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.
• Márta K, Lazarescu AM, Farkas N, et al. Aging and comorbidities in acute pancreatitis i: a meta-analysis and systematic review based on 194,702 patients. Front Physiol 2019; 10: 328
• Márta K, Kónya K, Szabó I, et al. Aging and comorbidities in acute pancreatitis II: a cohort-analysis of 1203 prospectively collected cases. Front Physiol 2019; 9: 1776.
• Petrov MS, Shanbhag S, Chakraborty M, Phillips ARJ, Windsor JA. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology 2010; 139: 813–20.
• Ranson JH, Pasternack BS. Statistical methods for quantifying the severity of clinical acute pancreatitis. J Surg Res 1977; 22: 79–91.
• Blamey SL, Imrie CW, O’Neill J, Gilmour WH, Carter DC. Prognostic factors in acute pancreatitis. Gut 1984; 25: 1340–6.
• Larvin M, McMahon MJ. APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet 1989; 2: 201–5.
• 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.
• Li M, Xing XK, Guo F. Evaluation of six scoring systems and four laboratory tests in the prognostic assessment of severe acute pancreatitis. Chin J Dig 2018; 38: 673–7.
• Hagjer S, Kumar N. Evaluation of the BISAP scoring system in prognostication of acute pancreatitis- a prospective observational study. Int J Surg 2018; 54: 76–81.
• Spanier BM, Dijkgraaf MG, Bruno MJ. Epidemiology, aetiology and outcome of acute and chronic pancreatitis: an update. Best Pract Res Clin Gastroenterol 2008; 22: 45–63.
• Quero G, Covino M, Fiorillo C, et al. Acute pancreatitis in elderly patients: a single-center retrospective evaluation of clinical outcomes. Scand J Gastroenterol 2019; 54: 492-8.
• Somasekar K, Foulkes R, Morris-Stiff G, Hassn A. Acute pancreatitis in the elderly - Can we perform better? Surgeon 2011; 9: 305-8.
• de Beaux AC, Palmer KR, Carter DC. Factors influencing morbidity and mortality in acute pancreatitis; an analysis of 279 cases. Gut 1995; 37: 121–6.
• Xin MJ, Chen H, Luo B, Sun JB. Severe acute pancreatitis in the elderly: etiology and clinical characteristics. World J Gastroenterol 2008; 14: 2517-21.
• Kim JE, Hwang JH, Lee SH, et al. The clinical outcome of elderly patients with acute pancreatitis is not different in spite of the different etiologies and severity. Arch Gerontol Geriatr 2012; 54: 256-60.
• Kayar Y, Dertli R, Konur S. Clinical outcomes of acute pancreatitis in elderly patients: An experience of single tertiary center. Pancreatology 2020; 20: 1296-301.
• He F, Zhu HM, Li BY, et al. Factors predicting the severity of acute pancreatitis in elderly patients. Aging Clin Exp Res 2021; 33: 183-92.
• Khanna AK, Meher S, Prakash S, et al. 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. HPB Surg 2013; 2013: 367581.
• Li Y, Zhang J, Zou J. Evaluation of four scoring systems in prognostication of acute pancreatitis for elderly patients. BMC Gastroenterol 2020; 20: 165.
• Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Localio SA. Objective early identification of severe acute pancreatitis. Am J Gastroenterol 1974; 61: 443-51.