A comparison of APACHE II,BISAP,Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification  

APACHE II、BISAP、Ranson评分和改良CTSI对急性胰腺炎严重程度(基于Atlanta 2012分类)预测价值的比较

作　　者：Anubhav Harshit Kumar Mahavir Singh Griwan 

机构地区：[1]Department of Surgery,Pt.B.D.Sharma PGIMS,Rohtak,India

出　　处：《Gastroenterology Report》2018年第2期127-131,I0002,I0003,共7页胃肠病学报道（英文）

摘　　要：Objective:Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation(APACHE)II,Bedside Index of Severity in Acute Pancreatitis(BISAP),Ranson’s score and modified Computed Tomography Severity Index(CTSI)in predicting the severity of acute pancreatitis based on Atlanta 2012 definitions in a tertiary care hospital in northern India.Methods:Fifty patients with acute pancreatitis admitted to our hospital during the period of March 2015 to September 2016 were included in the study.APACHE II,BISAP and Ranson’s score were calculated for all the cases.Modified CTSI was also determined based on a pancreatic protocol contrast enhanced computerized tomography(CT).Optimal cut-offs for these scoring systems and the area under the curve(AUC)were evaluated based on the receiver operating characteristics(ROC)curve and these scoring systems were compared prospectively.Results:Of the 50 cases,14 were graded as severe acute pancreatitis.Pancreatic necrosis was present in 15 patients,while 14 developed persistent organ failure and 14 needed intensive care unit(ICU)admission.The AUC for modified CTSI was consistently the highest for predicting severe acute pancreatitis(0.919),pancreatic necrosis(0.993),organ failure(0.893)and ICU admission(0.993).APACHE II was the second most accurate in predicting severe acute pancreatitis(AUC 0.834)and organ failure(0.831).APACHE II had a high sensitivity for predicting pancreatic necrosis(93.33%),organ failure(92.86%)and ICU admission(92.31%),and also had a high negative predictive value for predicting pancreatic necrosis(96.15%),organ failure(96.15%)and ICU admission(95.83%).Conclusion:APACHE II is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for tertiary care during the course of their illness and therefore need early resuscitation and prompt referral,especially in resource-limited developing countries.目的:本研究前瞻性比较了急性生理和慢性健康状况评分(APACHEⅡ)、急性胰腺炎严重程度床边指数(BISAP)、Ranson评分与改良CT严重度指数(CTSI)这四种方法,评估印度北部一家三甲医院急性胰腺炎患者疾病严重程度(基于Atlanta 2012分类)的准确性。方法:前瞻性纳入2015年3月至2016年9月间我院收治的50例急性胰腺炎患者,对所有入组病例进行APACHEⅡ、BISAP和Ranson评分,并基于胰腺对比增加CT进行改良CTSI评估。基于受试者工作特征(ROC)曲线评估这些评分系统预测急性胰腺炎严重程度的最佳阈值和曲线下面积(AUC),并对这些评分系统的预测价值进行前瞻性比较。结果:50例急性胰腺炎患者中14例被评估为重症急性胰腺炎。15例患者出现胰腺坏死,14例出现持续器官功能衰竭,14例需要收治重症监护室(ICU)。改良CTSI对重症急性胰腺炎、胰腺坏死、器官衰竭、入住ICU的预测价值均为最高,其AUC分别为0.919、0.993、0.893和0.993。APACHEⅡ对重症急性胰腺炎和器官衰竭的预测价值均仅次于改良CTSI,其AUC分别为0.934和0.931。APACHEⅡ对胰腺坏死、器官衰竭、入住ICU的预测具有较高的敏感性(分别为93.33%、92.86%和92.31%)和阴性预测值(分别为96.15%、96.15%和95.83%)。结论:APACHEⅡ是预测急性胰腺炎严重程度的一项有效的评估系统,有助于筛选出病情危重、需要早期复苏和尽快转诊上级医院的急性胰腺炎患者,尤其在一些医疗资源匮乏的发展中国家。

关 键 词：Acute pancreatitis Accuracy of Acute Physiology and Chronic Health Evaluation II(APACHE II) Bedside Index of Severity in Acute Pancreatitis(BISAP) Ranson’s score modified Computed Tomography Severity Index(modified CTSI) 

分 类 号：R57[医药卫生—消化系统]