Comparison of BISAP, Ranson's, APACHE-II, and CTSI Scores in Predicting Organ Failure, Complications, and Mortality in Acute Pancreatitis
Comparison of BISAP, Ranson's, APACHE-II, and CTSI Scores in Predicting Organ Failure, Complications, and Mortality in Acute Pancreatitis
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DOI：
10.1038/ajg.2009.622
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发表时间：
2010-02-01
影响因子：
9.8
通讯作者：
Whitcomb, David C.
中科院分区：
文献类型：
--
作者：
Papachristou, Georgios I.;Muddana, Venkata;Whitcomb, David C.
目的：在急性胰腺炎（AP）病程早期识别有重症风险的患者是指导管理和改善结局的重要一步。一个新的预后评分系统，床边指数严重程度在AP（BISAP），已被提出作为一个准确的方法，早期识别患者的危险，在医院死亡率。本研究的目的是比较BISAP（血尿素氮> 25 mg/dl、精神状态受损、全身炎症反应综合征（SIRS）、年龄> 60岁和胸腔积液），使用“传统”多因素评分系统：兰森，急性生理学和慢性健康检查（APACHE）-II和计算机断层扫描严重程度指数（CTSI）预测严重程度，胰腺坏死（PNec），方法：收集2003年6月至2007年9月间收治或转移到我们机构的连续AP患者的广泛人口统计学、影像学和实验室数据。BISAP和APACHE-II评分使用入院后前24小时的数据计算。评分系统的预测准确性进行了测量的受试者工作曲线下面积（AUC）。结果：有185例AP（平均年龄51.7，51%男性），其中73%进行了对比增强CT扫描。40例患者发生器官衰竭，并被归类为重度AP（SAP; 22%）。36例发生PNec（19%），7例死亡（死亡率3.8%）。BISAP评分>= 3的患者数量为26例;兰森评分= 3的患者数量为47例，APACHE-II评分= 8的患者数量为66例，CTSI评分= 3的患者数量为59例。在死亡的7名患者中，1名BISAP评分为1，2名评分为2，4名评分为3。BISAP、兰森、APACHE-II和CTSI预测SAP的AUC为0.81（置信区间（CI）0.74-0.87），0.94（置信区间0.89-0.97），0.78（CI 0.71-0.84）和0.84结论：我们证实BISAP评分是AP患者危险分层的准确方法。其成分与临床相关且易于获得。BISAP的预后准确性与其他评分系统相似。我们的结论是，简单的评分系统可能已经达到了最大的效用，需要新的模型来进一步提高预测的准确性。
OBJECTIVES: Identification of patients at risk for severe disease early in the course of acute pancreatitis (AP) is an important step to guiding management and improving outcomes. A new prognostic scoring system, the bedside index for severity in AP (BISAP), has been proposed as an accurate method for early identification of patients at risk for in-hospital mortality. The aim of this study was to compare BISAP (blood urea nitrogen > 25 mg/dl, impaired mental status, systemic inflammatory response syndrome (SIRS), age > 60 years, and pleural effusions) with the "traditional" multifactorial scoring systems: Ranson's, Acute Physiology and Chronic Health Examination (APACHE)-II, and computed tomography severity index (CTSI) in predicting severity, pancreatic necrosis (PNec), and mortality in a prospective cohort of patients with AP.METHODS: Extensive demographic, radiographic, and laboratory data from consecutive patients with AP admitted or transferred to our institution was collected between June 2003 and September 2007. The BISAP and APACHE-II scores were calculated using data from the first 24 h from admission. Predictive accuracy of the scoring systems was measured by the area under the receiver-operating curve (AUC).RESULTS: There were 185 patients with AP (mean age 51.7, 51% males), of which 73% underwent contrast-enhanced CT scan. Forty patients developed organ failure and were classified as severe AP (SAP; 22%). Thirty-six developed PNec (19%), and 7 died (mortality 3.8%). The number of patients with a BISAP score of >= 3 was 26; Ranson's = 3 was 47, APACHE-II = 8 was 66, and CTSI = 3 was 59. Of the seven patients that died, one had a BISAP score of 1, two had a score of 2, and four had a score of 3. AUCs for BISAP, Ranson's, APACHE-II, and CTSI in predicting SAP are 0.81 (confidence interval (CI) 0.74-0.87), 0.94 (CI 0.89-0.97), 0.78 (CI 0.71-0.84), and 0.84 (CI 0.76-0.89), respectively.CONCLUSIONS: We confirmed that the BISAP score is an accurate means for risk stratification in patients with AP. Its components are clinically relevant and easy to obtain. The prognostic accuracy of BISAP is similar to those of the other scoring systems. We conclude that simple scoring systems may have reached their maximal utility and novel models are needed to further improve predictive accuracy.