Comparison of the Efficacy of 5 Scoring Systems and 5 Biochemical Markers in Predicting the Severity of Acute Pancreatitis in the Indian Population

Priyankha, Balasundaram (2012) Comparison of the Efficacy of 5 Scoring Systems and 5 Biochemical Markers in Predicting the Severity of Acute Pancreatitis in the Indian Population. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.


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INTRODUCTION: Acute pancreatitis is a common emergency with potentially devastating consequences (1). It is protean in nature and presents across a wide spectrum of severity ranging from a mild, self-limiting disease to severe disease with fatal outcome. About 20 to 30 percent of patients with acute pancreatitis develop complications of necrosis, organ failure, or both. Unfortunately, the serum amylase level and the lipase level are not specific enough measures of disease activity to be used prognostically. AIMS AND OBJECTIVES: 1. To assess and compare the validity, specificity and sensitivity of 5 commonly used scoring systems and 5 biochemical markers in their ability to predict the outcome of acute pancreatitis in the Indian population presenting at our institution during the course of the study period. 2. To generate an algorithm which will help stratify patients admitted with acute pancreatitis into severe or mild forms of acute pancreatitis in the most effective way based on the collected data validating the scoring and biochemical markers. 3. To formulate a management plan based on the above algorithm, which will help distribute available resources with maximum efficiency. MATERIALS AND METHODS: Type of Data: Primary. Study Population: Patients diagnosed with acute pancreatitis presenting to the hospital within 72 hrs of onset of symptoms. Study Locale: Coimbatore, and surrounding localities, South India. Study Design: Prospective Observational. Sample Size: 30. Patients diagnosed with acute pancreatitis admitted consecutively within the designated study period. Inclusion Criteria: Patients diagnosed to have acute pancreatitis based on the following 2 criteria: 1. Abdominal pain characteristic of ap. 2. Serum amylase and / or lipase ≥ 3 times the upper limit of normal. Exclusion Criteria: Patients symptomatic for more than 72 hrs prior to admission Tool(s) of data collection: collection of demographic, clinical and laboratory data while the patient is admitted to the hospital within 24 hrs and 48 hrs. Duration of the study: 1 year. RESULTS: Early and accurate identification of patients with Severe Acute Pancreatitis is essential for adequate patient care and decision making. Correctly assessing and stratifying patients based on severity will enable us to make important evidence- based judgments on treatment options, the need for intensive care treatment, and/or special therapies that may alter the clinical course and finally the outcome. In my study on the validity of newer and older scoring systems and individual biochemical markers in our Indian population, there is a linear progression between the APACHE score, Ranson’s, the Glasgow-Imrie, BISAP and Modified Japanese Scoring systems which correlates with the severity of acute pancreatitis on initial presentation. The biochemical markers also correlated with severity of the disease, with BUN levels being the most accurate, while total lymphocyte count was the least accurate. This is in line with larger population based international studies. There was no correlation between amylase and lipase levels and the severity of the acute pancreatitis. The scoring systems outdid the individual clinical markers in sensitivity, specificity and positive predictive values. The BISAP score is the simplest to perform, is easily done at the bedside, easily reproducible and can be done on admission and it sensitivity, specificity and positive predictive value is on par with the present gold standard scoring systems. On the other hand, the Gold Standard scores the Ranson’s criteria and APACHE are more complicated to perform and require (in the case of Ranson’s) repeated data collection at specific time intervals. CONCLUSION: In my study I was able to validate that the BISAP scoring system is on par with the more established Ranson Criteria and APACHE II score in evaluating the severity of acute pancreatitis. The BISAP score proved to be easy to use, reliable and accurate in stratifying patients with severe disease. Although the new JSS also had similar results, which were statistically significant, the scoring system was harder gather data for as more criteria were involved in the calculations. Both the BISAP and New JSS were superior to the Glasgow- Imrie scoring system. In my study all the individual biochemical markers, although useful as adjuncts in the management and stratification of acute pancreatitis, were not as accurate as the scoring systems and were not upto par in terms of sensitivity, specificity and positive predictive value. Both the BUN and C-reactive protein proved to be valuable in predicting improvement in prognosis compared to the other three markers studied. Based on my observations and statistical calculations, I was able to draw a conclusion that, although cumbersome. The APACHE II was the most reliable scoring system and will continue to remain the gold standard for assessing acute pancreatitis until newer, improved, accurate, and easily performed scoring systems become available. With the conclusions drawn from my study, I was able to create the following basic algorithm which will be simple to implement in our day to day practice when faced with a case of acute pancreatitis. It will allow us to make earlier and fitting decisions, on a firm evidence-based platform. This will permit suitable allotment of resources, including management of deserving cases with poorer prognosis due to severe disease in an appropriate ICU setting.

Item Type: Thesis (Masters)
Additional Information: Reg.No.22091353
Uncontrolled Keywords: Efficacy of 5 Scoring Systems, 5 Biochemical Markers, Predicting, Severity of Acute Pancreatitis, Indian Population.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 14 Sep 2020 17:52
Last Modified: 15 Sep 2020 16:12

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