DOI: http://dx.doi.org/10.18203/2349-2902.isj20191882

Comparison of Ranson’s and Glasgow criteria with revised Atlanta in prediction of mortality in acute pancreatitis patients

Deepa Nambi, Bhanumati Giridharan

Abstract


Background: To compare the performance of Ranson’s Score (RS) and Glasgow Score (GS) with Revised Atlanta Classification (RAC) in prediction of mortality, and to check their suitability to replace RAC for surgical intervention of gallstone induced acute pancreatitis (GAP).

Methods: A hospital based prospective study was conducted between April 2014 and May 2017 with patients presenting with GAP. RS and GS was evaluated using data in first 24 hours and at 48 hours post admission. Patients were classified into mild, moderate and severe based on RAC at the time of hospital stay. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each scoring system. Receiver Operating Characteristics (ROC) curves for mortality, ICU admission, Organ Failure (OF) and Gallstone Recurrence (GR) were plotted and predictive accuracy of each scoring system was measured by the Area under Curve (AUC). AUC values were compared for statistical significance using De Long test. A p-value of <0.05 was considered statistically significant.

Results: Of 81 patients, 15 patients had OF and local complication classified as SAP, with persistent OF (16.0%). The AUC for RS was consistently the highest for predicting mortality (0.943), recurrence of gallstone (0.766), ICU-admission (0.801) and OF (0.852). RS had high specificity (61.9%), PPV (88.2%), Accuracy (90.1%) for predicting mortality, recurrence of gallstone and OF. Glasgow criteria had high sensitivity (85.1%), NPV (79.4) in predicting ICU-admission.

Conclusions: RS in comparable with RAC in predicting mortality, GR in patients with GAP and early referral for surgical intervention.


Keywords


Gallstone induced acute pancreatitis, Glasgow score, Ranson’s score, Revised Atlanta classification

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References


National Institutes of Health. Pancreatitis [Internet]. 2019 [cited 2019 Jan 3]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis.

Khanna AK, Meher S, Prakash S, Tiwary SK, Singh U, Srivastava A, et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis. HPB Surg. 2013;24;:1-10.

Larrosa A, Sánchez CA, Villa A, Macias R, Martinez E. Increasing Incidence Of Acute Pancreatitis And Recurrent Pancreatitis As An Emergent Syndrome. J Pediatr Gastroenterol Nutr 2006;43(4).

Roberts SE, Akbari A, Thorne K, Atkinson M, Evans PA. The incidence of acute pancreatitis: impact of social deprivation, alcohol consumption, seasonal and demographic factors. Aliment Pharmacol Ther. 2013;38(5):539-48.

Vege SS, Whitcomb DC, Grover S. Etiology of acute pancreatitis. uptodate. 2019. Available from: https://www.uptodate.com/contents/etiology-of-acute-pancreatitis

Xiao AY, Tan MLY, Wu LM, Asrani VM, Windsor JA, Yadav D, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol. 2016;1(1):45-55.

Yadav D, Lowenfels AB. The Epidemiology of Pancreatitis and Pancreatic Cancer. Gastroenterol. 2013;144(6):1252–61.

Pang Y, Kartsonaki C, Turnbull I, Guo Y, Yang L, Bian Z, et al. Metabolic and lifestyle risk factors for acute pancreatitis in Chinese adults: A prospective cohort study of 0.5 million people. Ma RCW, editor. PLOS Med. 2018;15(8):e1002618.

Manrai M, Kochhar RK, Thandassery RB, Alfadda AA, Sinha SK. The Revised Atlanta Classification of Acute Pancreatitis : A Work Still in Progress ? In 2015.

Carnovale A, Rabitti PG, Manes G, Esposito P, Pacelli L, Uomo G. Mortality in acute pancreatitis: is it an early or a late event? JOP. 2005 10;6(5):438-44.

Roberts SE, Thorne K, Evans PA, Akbari A, Samuel DG, Williams JG. Mortality following acute pancreatitis: social deprivation, hospital size and time of admission: record linkage study. BMC Gastroenterol. 2014;14(1):153.

Lerch MM, Aghdassi A. Gallstone-related pathogenesis of acute pancreatitis. Pancreapedia Exocrine Pancreas Knowl Base. 2016; Available at: https://www.pancreapedia.org/reviews/gallstone-related-pathogenesis-of-acute-pancreatitis Accessed on 3 November 2018.

Portincasa P, Ciaula A Di, Bonfrate L, Wang DQ. Therapy of gallstone disease: What it was, what it is, what it will be. World J Gastrointest Pharmacol Ther. 2012;3(2):7-20.

Kimura Y, Arata S, Takada T, Hirata K, Yoshida M, Mayumi T, et al. Gallstone-induced acute pancreatitis. J Hepatobiliary Pancreat Sci. 2010;17(1):60-9.

Cappell MS. Acute Pancreatitis: Etiology, Clinical Presentation, Diagnosis, and Therapy. Med Clin North Am. 2008 Jul;92(4):889–923.

Lippi G, Valentino M, Cervellin G. Laboratory diagnosis of acute pancreatitis: in search of the Holy Grail. Crit Rev Clin Lab Sci. 2012;49(1):18–31.

Abraham S, Rivero HG, Erlikh I V, Griffith LF, Kondamudi VK. Surgical and nonsurgical management of gallstones. Am Fam Physician 2014;89(10):795–802.

Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology Guideline: Management of Acute Pancreatitis. Am J Gastroenterol. 2013;108(9):1400–15.

Kumar AH, Griwan MS. A comparison of APACHE II, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification. Gastroenterol Rep. 2018;6(2):127–31.

Zhao K, Adam SZ, Keswani RN, Horowitz JM, Miller FH. Acute Pancreatitis: Revised Atlanta Classification and the Role of Cross-Sectional Imaging. Am J Roentgenol. 2015 Jul;205(1):W32–41.

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.

Cho JH. Comparison of scoring systems in predicting the severity of acute pancreatitis. World J Gastroenterol. 2015;21(8):2387.

Cai D, Parajuly SS, Wang H, Wang X, Ling W, Song B, et al. Accuracy of contrast-enhanced ultrasound compared with conventional ultrasound in acute pancreatitis: Diagnosis and complication monitoring. Exp Ther Med. 2016;12(5):3189-94.

Epocrates. Acute pancreatitis. 2019. Available from: https://online.epocrates.com/diseases/6636/Acute-pancreatitis/Diagnostic-Criteria

Simoes. Predicting Acute Pancreatitis Severity: Comparison of Prognostic Scores. Gastroenterol Res 2011. Available from: http://www.gastrores. org/index.php/Gastrores/article/view/364. Accessed on 3 November 2018.

Maheshwar A, Mohan S, Prasath R, Rajalakshmi K. Comparison Study of Apache-II Vs Ranson’s scoring And CT Severity Index for Its Outcome in Acute Pancreatitis In MMC & RI. IOSR J Dent Med Sci. 2017;16(6):15–24.

Dean B, Uppal H, Singh S, Wright K. Management of gallstones in elderly patients. Gastroenterol. 2009; 557–61.

González González JJ, Sanz Alvarez L, Graña López JL, Bermejo Abajo G, Navarrete Guijosa F, Martínez Rodríguez E. Gallstone disease in patients over the age of 80. Surgery or long-term medical treatment? Rev Esp Enferm Dig. 1997;89(3):196–205.

Krarup T, Sønderstrup J, Kruse-Blinkenberg HO, Schmidt A. Surgery for gallstones in old age: do we operate too late? Acta Chir Scand. 1982;148(3):263-6.

Erlinger S. Gallstones in obesity and weight loss. Eur J Gastroenterol Hepatol. 2000;12(12):1347-52.

Stender S, Nordestgaard BG, Tybjaerg-Hansen A. Elevated body mass index as a causal risk factor for symptomatic gallstone disease: A Mendelian randomization study. Hepatol. 2013;58(6):2133–41.

Ghatak R, Masso L, Kapadia D, Kulairi ZI. Medication as a Cause of Acute Pancreatitis. Am J Case Rep. 2017;18:839–41.

Ikard RW. Gallstones, cholecystitis and diabetes. Surg Gynecol Obstet. 1990;171(6):528-32.

Diabetes Foundation India. Diabetes Foundation (India) 2019 Available from: http://www. diabetesfoundationindia.org/about.htm. Accessed on 3 November 2018.

Ghimire P, Ghimire S. Comparison of Different Scoring System in Predicting the Severity and Prognosis of Acute Pancreatitis. 2018;17(5):56-60.

Ruan GJ, Bhimji SS. Ranson Criteria. StatPearls. Treasure Island (FL): StatPearls Publishing; 2019.