Diagnostic value of integral scoring systems in assessing the severity of acute pancreatitis and patient's condition

Abstract

Objective: The aim of the study was to evaluate the diagnostic value of specific and nonspecific scoring systems Tolstoy-Krasnogorov score, Ranson, BISAP, Glasgow, MODS 2, APACHE II and CTSI, which used at urgent pancreatology for estimation the severity of acute pancreatitis and status of patient. Methods: 1550 case reports of patients which had inpatient surgical treatment at Road clinical hospital at the station Krasnoyarsk from 2009 till 2013 were analyzed. Diagnosis of severe acute pancreatitis and its complications were determined based on anamnestic data, physical examination, clinical indexes, ultrasonic examination and computed tomography angiography. Specific and nonspecific scores (scoring system of estimation by Tolstoy-Krasnogorov, Ranson, Glasgow, BISAP, MODS 2, APACHE II, CTSI) were used for estimation the severity of acute pancreatitis and patient's general condition. Effectiveness of these scoring systems was determined based on some parameters: accuracy (Àñ), sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Results: Most valuables score for estimation of acute pancreatitis's severity is BISAP (Se - 98,10%), for estimation of organ failure - MODS 2 (Sp - 100%, PPV - 100%) and APACHE II (Sp - 100%, PPV - 100%), for detection of pancreatonecrosis sings - CTSI (Sp - 100%, NPV - 100%), for estimation of need for intensive care - MODS 2 (Sp - 100%, PPV - 100%, NPV - 96, 29%) and APACHE II (Sp - 100%, PPV - 100%, NPV - 97, 21%), for prediction of lethality - MODS 2 (Se - 100%, Sp - 98, 14%, NPV - 100%) and APACHE II (Se - 95, 00%, NPV - 99, 86%). Conclusion: Most effective scores for estimation of acute pancreatitis's severity are Score of estimation by Tolstoy -Krasnogorov, Ranson, Glasgow and BISAP. Scoring systems MODS 2, APACHE II high specificity and positive predictive value allow using it at clinical practice.