Üçüncü basamak bir hastanenin acil servisine sevk edilen akut pankreatitli hastalarýn þiddetinin öngörülmesinde farklý risk sýnýflandýrma sistemlerinin karþýlaþtýrýlmasý

AMAÇ: Erken evre akut pankreatitte (AP) prognoz ve þiddetin tahmini mortalite ve komplikasyon oranlarýnýn azaltýlmasý için önemlidir. Bu çalýþma-nýn amacý, AP’nin farklý klinik ve radyolojik skorlamalarýn öngörme yeteneðini deðerlendirmektir.
GEREÇ VE YÖNTEM: Ocak 2017 Aralýk 2019 tarihleri arasýnda Çanakkale Onsekiz Mart Üniversitesi Hastanesi’ne kabul edilen AP tanýlý 159 has-tanýn klinik ve demografik verilerini geriye dönük olarak topladýk. Akut pankreatit þiddeti için yatak baþý indeks (BISAP) ve akut fizyoloji ve kronik saðlýk deðerlendirme II (APACHEII) kabulde, Ranson ve modifiye Glasgow Prognostik Skor (mGPS) puanlarý kabulden sonraki 48. saatte hesaplandý. Ayrýca modifiye CTSI her hastada hesaplandý. Eðri Altýnda Kalan Alan (AUC), Alýcý Ýþletim Karakteristiði (ROC) eðrilerinden optimal kesme deðerleri kararlaþtýrýlarak her skor sistemi için, þiddetli AP öngörme, pankreatik nekroz, hastanede kalma süreleri ve mortalite için hesaplandý. BULGULAR: mGPS ve APACHE II skorlarýnýn baþvuru anýnda þiddetli AP’nin tahmininde en iyi duyarlýlýk ve özgüllükle en yüksek AUC (sýrasýyla 0.929 ve 0.823) deðerine sahip olduðu tespit edilmiþtir. Mortalitenin tahmininde BISAP [duyarlýlýk, özgüllük, NPD ve PPD sýrasýyla: %75.0, %70.9, %98.2 ve %12.0 (AUC: 0.793)] ve APACHE II [duyarlýlýk, özgüllük, NPD ve PPD sýrasýyla: %87.5, %86.1, %99.2 ve %25.0 (AUC: 0.840)]. TARTIÞMA: mGPS hastalarýn þiddetli AP geçirme olasýlýðýnýn tahmininde BISAP skoru, APACHE II Ranson skoru ve mCTSI’ye kýyasla daha etkin bir skorlama sistemi olduðu savunulabilir.

Comparison of different risk stratification systems for prediction of acute pancreatitis severity in patients referred to the emergency department of a tertiary care hospital

BACKGROUND: Prognostic prediction and estimation of severity at early stages of acute pancreatitis (AP) are crucial to reduce the complication rates and mortality. The objective of the present study is to evaluate the predicting ability of different clinical and radiological scores in AP.
METHODS: We retrospectively collected demographic and clinical data from 159 patients diagnosed with AP admitted to Canakkale Onsekiz Mart University Hospital between January 2017 and December 2019. Bedside index for severity AP (BISAP), and acute phys-iology and chronic health evaluation II (APACHE II) score at admission, Ranson and modified Glasgow Prognostic Score (mGPS) score at 48 h after admission were calculated. Modified computed tomography severity index (CTSI) was also calculated for each patient. Area under the curve (AUC) was calculated for each scoring system for predicting severe AP, pancreatic necrosis, length of hospital stay, and mortality by determining optimal cutoff points from the (ROC) curves.
RESULTS: mGPS and APACHE II had the highest AUC (0.929 and 0.823, respectively) to predict severe AP on admission with the best specificity and sensitivity. In predicting mortality BISAP (with a sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 75.0%, 70.9%, 98.2%, and 12.0%, respectively, [AUC: 0.793]) and APACHE II (with a sensitivity, specificity, NPV and PPV of 87.5%, 86.1%, 99.2%, and 25.0%, respectively, [AUC: 0.840]).
CONCLUSION: mGPS can be a valuable tool in predicting the patients more likely to develop severe AP and maybe somewhat better than BISAP score, APACHE II Ranson score, and mCTSI.