Retrospective Study
Copyright ©The Author(s) 2015.
World J Gastroenterol. Feb 28, 2015; 21(8): 2387-2394
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2387
Table 1 Characteristics of patients with severe acute pancreatitis n (%)
Mild to moderately severe AP (n = 140)Severe AP(n = 21)P value
Age, yr62.2 ± 16.563.4 ± 13.10.968
Male84 (60.0)18 (85.7)0.023
BMI (kg/m2)23.4 ± 4.423.9 ± 4.10.607
Hospital visit from symptom onset (d)5.7 ± 12.83.3 ± 6.90.388
Etiology
Biliary78 (55.7)9 (42.8)0.270
Alcoholic26 (18.6)10 (47.6)0.030
Idiopathic33 (23.6)1 (4.8)0.130
Others3 (2.1)1 (4.8)0.472
Laboratory finding (initial)
Hematocrit (%)39.1 ± 6.240.3 ± 7.40.422
Amylase (IU/L)1687.9 ± 1415.41668.2 ± 1668.80.954
Lipase (IU/L)1949.7 ± 1951.32108.2 ± 2750.30.744
AST (IU/L)203.2 ± 240.4362.6 ± 618.40.256
ALT (IU/L)155.6 ± 182.1184.7 ± 275.90.645
BUN (mg/dL)14.5 ± 8.631.2 ± 32.90.031
Creatinine (mg/dL)1.0 ± 0.52.2 ± 1.60.003
CRPi (mg/dL)4.4 ± 6.86.9 ± 10.40.259
CRP24 (mg/dL)9.0 ± 7.917.4 ± 12.70.026
Peripancreatic fluid collection46 (32.9)10 (47.6)0.158
Duration of NPO (d)4.3 ± 2.26.9 ± 5.10.038
Hospital stay (d)8.4 ± 4.811.7 ± 6.20.008
Scoring systems
Ranson2.7 ± 1.43.7 ± 1.40.005
BISAP1.0 ± 0.81.9 ± 0.9< 0.001
APACHE-II6.5 ± 3.510.8 ± 4.8< 0.001
CTSI2.2 ± 1.43.5 ± 2.2< 0.001
Mortality1 (0.7)2 (9.5)0.005
Values are expressed as the mean ± SD. AP: Acute pancreatitis; BMI: Body mass index; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CRPi: C-reactive protein measured at admission; CRP24: C-reactive protein measured after 24 h; NPO: Nil per os; BISAP: Bedside Index for Severity in Acute Pancreatitis; APACHE-II: Acute Physiology and Chronic Health Evaluation-II; CTSI: Computed tomography severity index.
Table 2 Correlation analysis of various scoring systems
RansonBISAPAPACHE-IICTSICRPiCRP24
Ransonr10.580.60-0.030.280.22
P-value< 0.001< 0.0010.6930.0010.045
BISAPr10.54-0.050.330.28
P-value< 0.0010.498< 0.0010.009
APACHE-IIr1-0.010.320.37
P-value0.905< 0.001< 0.001
CTSIr10.070.44
P-value0.427< 0.001
CRPir10.59
P-value< 0.001
CRP24r1
P-value
BISAP: Bedside Index for Severity in Acute Pancreatitis; APACHE-II: Acute Physiology and Chronic Health Evaluation-II; CTSI: Computed tomography severity index; CRPi: C-reactive protein measured at admission; CRP24: C-reactive protein measured after 24 h.
Table 3 Incidence of severe acute pancreatitis stratified according to bedside index for severity in acute pancreatitis, Ranson, Acute Physiology and Chronic Health Evaluation-II, computed tomography severity index, and C-reactive protein with corresponding odds ratio n (%)
PatientsSevere AP
Ranson
< 265 (40.4)3 (4.6)
≥ 396 (59.6)18 (18.8)
OR (95%CI)4.8 (1.3-16.9)
BISAP
< 1109 (67.7)8 (7.3)
≥ 252 (22.3)13 (25.0)
OR (95%CI)4.2 (1.6-10.9)
APACHE-II
< 765 (40.4)4 (6.2)
≥ 896 (59.6)17 (17.7)
OR (95%CI)8.2 (2.6-25.6)
CTSI
< 2101 (62.7)7 (6.9)
≥ 360 (37.3)14 (23.3)
OR(95%CI)4.1 (1.5-10.8)
CRP24
< 21.472 (85.7)6 (8.3)
≥ 21.412 (14.3)8 (66.7)
OR (95%CI)22.0 (5.1-95.0)
AP: Acute pancreatitis; BISAP: Bedside Index for Severity in Acute Pancreatitis; APACHE-II: Acute Physiology and Chronic Health Evaluation-II; CTSI: Computed tomography severity index; CRP24: C-reactive protein measured after 24 h.
Table 4 Sensitivity, specificity, positive predictive value, and negative predictive value of different scoring systems in prediction of severe acute pancreatitis
Sensitivity (95%CI)Specificity (95%CI)PPV (95%CI)NPV (95%CI)
Ranson85.7 (63.7-97.0)44.3 (35.9-52.9)18.8 (11.5-28.0)95.3 (87.1-99.0)
BISAP61.9 (38.4-81.9)72.1 (63.9-79.4)25.0 (14.0-38.9)92.7 (86.0-96.8)
APACHE-II81.0 (58.1-94.6)65.7 (57.2-73.5)26.2 (16.0-38.5)95.8 (89.7-98.9)
CTSI66.7 (43.0-85.4)67.1 (58.7-74.8)23.3 (13.4-36.0)93.1 (86.2-97.2)
CRP2453.3 (26.6-78.7)94.3 (86.0-98.4)66.7 (34.9-90.1)90.4 (81.2-96.1)
AP: Acute pancreatitis; PPV: Positive predictive value; NPV: Negative predictive value; BISAP: Bedside Index for Severity in Acute Pancreatitis; APACHE-II: Acute Physiology and Chronic Health Evaluation-II; CTSI: Computed tomography severity index; CRP24: C-reactive protein measured after 24 h.