Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence

Table 1 Comparison of existing clinical scoring systems used in patients with acute pancreatitis for predicting the severity of acute pancreatitis, such as severe acute pancreatitis, mortality, organ failure, intensive care unit admission, location complications, in-hospital adverse events, and pancreatic necrosis

Prediction	Scoring system (cutoff value)	Sensitivity, %	Specificity, %	Accuracy, %	PPV, %	NPV, %	AUC	No. of patients	Ref.
MSAP and SAP1	BISAP (≥ 3)	54	86	-	68	-	0.795	326	[107]
	Ranson (≥ 3)	46	84	-	54	-	0.766
	APACHE II (≥ 8)	57	89	-	67	-	0.814
	MCTSI (≥ 4)	36	94	-	66	-	0.654
SAP1	Ranson (≥ 3)	85.7	44.3	-	18.8	95.3	0.69	161	[106]
	BISAP (≥ 2)	61.9	72.1	-	25.0	92.7	0.74
	APACHE II (≥ 8)	81.0	65.7	-	26.2	95.8	0.78
	CTSI (≥ 3)	66.7	67.1	-	23.3	93.1	0.69
SAP1,2	Ranson (≥ 4/≥ 3)	81.4/92.0	84.2/92.8	-	28.9/37.7	98.3/99.6	0.867/0.964	368/550	[110]
	BISAP (≥ 3/≥ 2)	88.9/96.0	86.5/88.0	-	34.3/27.6	99.0/99.8	0.922/0.942
	APACHE II (≥ 9/≥ 8)	85.2/96.0	61.0/93.0	-	14.7/42.9	98.1/99.8	0.784/0.951
	Glasgow (≥ 3/≥ 2)	85.2/80.0	84.2/88.2	-	29.9/24.4	98.6/98.9	0.913/0.881
SAP	HAPS (≥ 1)	79.0	49.7	53.3	18.2	94.4	0.687	653	[111]
	BISAP (≥ 3)	24.7	95.3	86.5	42.6	89.9	-
	APACHE II (≥ 8)	80.2	63.3	65.4	23.6	95.8	-
	Ranson (≥ 3)	92.6	51.9	57.0	21.4	98.0	0.857
	Glasgow (≥ 3)	76.5	68.5	69.5	25.6	95.4	-
	SOFA (≥ 7)	13.6	99.7	89.0	84.6	89.1	0.966
SAP3	APACHE II (≥ 6)	50	100	68.3	100	53.57	0.771	164	[112]
	BISAP (≥ 2)	25.96	100	53.1	100	43.80	0.640
	Modified Glasgow ≥ 3)	75.96	100	84.8	100	70.59	0.649
	Ranson (≥ 2)	32.69/58.65	100/100	57.3/73.8	100/100	46.15/58.25	0.848/0.817
SAP3,4	APACHE II (≥ 6)	63.7	77.1	68.2	84.6	51.9	-	69	[112]
	BISAP (≥ 2)	31.8	85.7	50.0	81.4	38.9	-
	Modified Glasgow (≥ 3)	79.9	31.4	63.4	69.6	44.0	-
	Ranson (≥ 2)	44.9/63.7	91.4/51.4	60.5/59.6	91.1/72.1	45.7/41.8	-
Mortality1	BISAP (≥ 3)	89	80	-	15	-	0.867	326	[107]
	Ranson (≥ 3)	78	77	-	9	-	0.842
	APACHE II (≥ 8)	89	78	-	10	-	0.854
	MCTSI (≥ 4)	78	86	-	14	-	0.839
Mortality in AP	HAPS (≥ 1)	83.3	46.6	29.9	2.8	99.3	-	653	[111]
	BISAP (≥ 3)	25	93.1	91.9	6.4	98.5	-
	APACHE II (≥ 8)	100	58.7	59.1	3.6	100	-
	Ranson (≥ 3)	100	47.3	48.2	3.4	100	0.917
	Glasgow ≥ 3)	75.0	63.8	64.2	4.1	99.5	-
	SOFA (≥ 7)	50.0	98.9	98.0	46.2	99.1	0.968
Mortality1	BISAP (≥ 2.5)	92.0	90.0	-	-	-	0.92	106	[113]
	HAPS (≥ 1.5)	49.0	98.0	-	-	-	0.83
	Ranson (≥ 3.5)	75.0	71.0	-	-	-	0.78
	JSS (≥ 3.5)	84.0	94.0	-	-	-	0.92
	Glasgow (≥ 2.5)	89.0	86.0	-	-	-	0.91
	APACHE II (≥ 5.5)	90.0	92.0	-	-	-	0.94
Persistent organ failure1,5	APACHE II (≥ 7)	84/94	71/44	-	49/14	93/99	0.77/0.71	256/397	[105]
	BISAP (≥ 2)	61/62	84/76	-	54/20	87/96	0.72/0.69
	Glasgow (≥ 2)	85/65	83/82	-	61/22	95/97	0.84/0.74
	HAPS (≥ 1)	70/73	53/58	-	32/12	85/97	0.62/0.66
	JSS (≥ 2)	59/42	92/89	-	70/23	88/95	0.76/0.66
	Ranson (≥ 2)	66/46	78/80	-	49/16	88/95	0.72/0.63
	SIRS (≥ 2)	70/69	71/58	-	43/11	88/96	0.70/0.64
Organ failure1	Ranson (≥ 3)	88.89	96.67	-	88.89	96.67	0.757	50	[108]
	BISAP (≥ 3)	90.00	83.87	-	64.29	96.30	0.762
	APACHE II (≥ 8)	92.86	69.44	-	54.17	96.15	0.831
	MCTSI (> 4)	92.86	75.00	-	59.09	96.43	0.893
Association with organ failure3	APACHE II (≥ 6)	48.5	36.2	40.3	27.8	28.1		164	[112]
	BISAP (≥ 2)	8.5	55	39.4	8.8	54.2	0.640
	Modified Glasgow (≥ 3)	68.5	20.2	36.5	30.3	56	0.649
	Ranson (≥ 2)	14.2/22.8	68.1/36.2	50/31.7	18.5/15.3	61/48	0.848/0.817
ICU admission1	Ranson (≥ 3)	80.00	96.55	-	88.89	93.33	0.910	50	[108]
	BISAP (≥ 3)	90.91	86.67	-	71.43	96.30	0.877
	APACHE II (≥ 8)	92.31	65.71	-	50.00	95.83	0.885
	MCTSI (> 4)	92.86	75.00	-	59.09	96.43	0.993
ICU admission	HAPS ≥ 1	90.0	47.2	29.9	5.1	99.3	-	653	[111]
	BISAP ≥ 3	25.0	93.4	91.3	10.6	97.5	-
	APACHE II ≥ 8	100	59.6	60.5	6.6	100	-
	Ranson ≥ 3	100	47.9	49.5	5.7	100	0.946
	Glasgow ≥ 3	75.0	64.5	65.1	7.0	99.3	-
	SOFA ≥ 7	40.0	99.2	97.4	61.5	98.1	0.943
Location complications1	BISAP (≥ 3)	54	81	-	21	-	0.731	326	[107]
	Ranson (≥ 3)	57	79	-	20	-	0.698
	APACHE II (≥ 8)	43	78	-	15	-	0.580
	MCTSI (≥ 4)	68	90	-	38	-	0.791
In-hospital adverse events1,6	HAPS ≥ 2	66.2	70.6		36.0	89.1	0.70	690	[109]
	Ranson ≥ 3	66.9	62.8	-	31.2	88.3	0.68
	BISAP ≥ 2	61.9	75.9	-	39.3	88.7	0.74
	Glasgow ≥ 2	51.8	83.7	-	44.0	87.3	0.71
	JSS7	81.9	66.0	-	38.2	93.4	0.80
Pancreatic necrosis1	Ranson (≥ 3)	80.00	96.55	-	88.89	93.33	0.910	50	[108]
	BISAP (≥ 3)	81.82	83.33	-	64.29	92.59	0.822
	APACHE II (≥ 8)	93.33	71.43	-	58.33	96.15	0.855
	MCTSI (> 4)	93.33	77.14	-	63.64	96.43	0.993

¹The predictive accuracy of each scoring system was measured by the area under the curve.

²In this study, 918 patients with were divided into two groups, namely the elderly group (368 patients who were ≥ 60-years-old) and the younger group (550 patients who were < 60-years-old). The former value corresponds to the elderly group, and the latter value corresponds to the younger group.

³The Ranson score in this study involved two time points: at admission and 48-h after admission. For Ranson, the former value corresponds to at admission, and the latter value corresponds to 48-h after admission.

⁴Computed tomography (CT) abdomen in 69 patients showed modified CT severity index ≥ 8 in all 69 (100%) patients.

⁵In this study, two prospective cohorts were involved, namely the training cohort and the validation cohort. The former value corresponds to the training cohort, and the latter value corresponds to the validation cohort.

⁶In-hospital adverse events included all in-hospital complications, pancreatic necrosis, and in-hospital mortality.

⁷Severe acute pancreatitis according to the Japanese Severity Score was defined if the prognostic factor was ≥ 3 or CT grade ≥ 2.

AP: Acute pancreatitis; APACHE: Acute Physiology and Chronic Health Evaluation; AUC: Area under the curve; BISAP: Bedside Index for Severity in Acute Pancreatitis; CTSI: Computed tomography severity index; HAPS: Harmless acute pancreatitis score; ICU: Intensive care unit; JSS: Japanese Severity Score; MCTSI: Modified Mortele’s computed tomography severity index; MSAP: Moderately severe acute pancreatitis; NPV: Negative predictive value; PPV: Positive predictive value; SAP: Severe acute pancreatitis; SIRS: Systemic Inflammatory Response Syndrome; SOFA: Sequential Organ Failure Assessment.