Comparative evaluation of various scoring systems to predict prognosis in patients with acute biliary pancreatitis

Yıl 2021, Cilt: 20 Sayı: 1, 32 - 43, 14.05.2021

Gökhan Tazegül Mete Akın Bülent Yıldırım

https://doi.org/10.17941/agd.931014

Öz

Background and Aims: To identify the severity of pancreatitis in patients diagnosed with acute biliary pancreatitis, and it also seeks to assess the congruence between the revised Atlanta classification and clinical and laboratory findings and prognostic scoring systems. Materials and Methods: A total of sixty-six patients with biliary pancreatitis were evaluated with revised Atlanta classification. Ranson score, Glasgow-Imrie score, Bedside Index of Severity in Acute Pancreatitis, Harmless Acute Pancreatitis Score, Japanese Severity Score, Acute Physiology and Chronic Health Evaluation-II, Sequential Organ Failure Assessment score, albumin-bilirubin grade were evaluated and compared, along with clinical and laboratory findings. SPSS Windows version 23.0 and Medcalc 19.2 were used in the analysis. Results: Bedside Index of Severity in Acute Pancreatitis had the highest correlation coefficient in differentiating moderate and severe pancreatitis. Glasgow-Imrie, albumin-bilirubin grade (48 h) and Japanese Severity Score score and Sequential Organ Failure Assessment score were also moderately correlated. Albumin-bilirubin grade (admission) and Harmless Acute Pancreatitis Score were weakly correlated. No correlation was found with the Ranson score and Acute Physiology and Chronic Health Evaluation score. The presence of albumin-bilirubin grade 3 at 48th hour increases the risk of moderate and severe pancreatitis by 17 times. Presence of antibiotic use increases the risk 6.6 times and positive Bedside Index of Severity in Acute Pancreatitis score increases the risk 4.7 times. Conclusion: The use of multiple scoring systems or co-evaluation of laboratory data can increase the sensitivity and specificity of clinical decisions. Combined use of Bedside Index of Severity in Acute Pancreatitis and antibiotherapy requirement is a candidate for predicting moderate and severe pancreatitis. Further studies on albumin-bilirubin grade, especially in acute biliary pancreatitis, are necessary.

Anahtar Kelimeler

Pancreatitis, biliary pancreatitis, prognosis, prognostic scores

Akut biliyer pankreatitli hastalarda prognozu öngörmede çeşitli skorlama sistemlerinin karşılaştırmalı değerlendirilmesi

Öz

Giriş ve Amaç: Bu çalışmada, (i) akut biliyer pankreatitli hastalarda pankreatitin şiddetini belirlemek, (ii) revize edilmiş Atlanta sınıflandırmasına göre şiddet ile klinik ve laboratuvar bulgular ve prognostik skorlama sistemlerinin uyumunun değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmada, biliyer pankreatit tanısı almış toplam altmış altı hasta revize Atlanta sınıflandırması ile değerlendirilmiştir. Ranson skoru, Glasgow-Imrie skoru, Yatak Başı Akut Pankreatit Şiddet İndeksi (Bedside Index of Severity in Acute Pancreatitis), Zararsız Akut Pankreatit Skoru, Japon Şiddet Skoru, Akut Fizyoloji ve Kronik Sağlık Değerlendirme (Acute Physiology and Chronic Health Evaluation-II), Ardışık Organ Yetmezliği Değerlendirmesi (Sequential Organ Failure Assessment) skoru ve albümin-bilirübin skoru değerlendirilmiş; klinik ve laboratuvar bulguları ile karşılaştırılmıştır. Analizde, SPSS Windows sürüm 23.0 ve Medcalc 19.2 kullanılmıştır. Bulgular: Yatak Başı Akut Pankreatit Şiddet İndeksi, orta ve şiddetli pankreatiti ayırt etmede en yüksek korelasyon katsayısına sahipti. Glasgow-Imrie, albümin-bilirübin skoru (48 saat), Japon Şiddet Skoru skoru ve Ardışık Organ Yetmezliği Değerlendirmesi skoru da orta derecede korelasyona sahipti. Albümin-bilirübin skoru (başvuru) ve Zararsız Akut Pankreatit Skoru zayıf bir şekilde korele saptandı. Ranson skoru ve Akut Fizyoloji ve Kronik Sağlık Değerlendirme skoru ile pankreatit şiddeti arasında herhangi bir korelasyon bulunmadı. 48. saatte albümin-bilirübin grade 3 varlığı, orta ve şiddetli pankreatit riskini 17 kat arttırmaktaydı. Antibiyotik kullanım gerekliliğinin riski 6.6 kat, Yatak Başı Akut Pankreatit Şiddet İndeksi skoru pozitifliğinin ise riski 4.7 kat arttırmakta olduğu gösterilmiştir. Sonuç: Skorlama sistemlerinin çoklu kullanılması veya laboratuvar verileri ile beraber değerlendirilmesi, klinik kararların duyarlılığını ve özgüllüğünü arttırabilir. Yatak Başı Akut Pankreatit Şiddet İndeksi ve antibiyoterapi gerekliliğinin kombine kullanımı, orta ve şiddetli pankreatiti tahmin etmeye aday bir çoklu kullanım örneğidir. Özellikle akut biliyer pankreatitte albümin-bilirübin skoru ile ilgili daha ileri çalışmalar gereklidir.

Anahtar Kelimeler

Pankreatit, biliyer pankreatit, prognoz, prognostik skorlar

Kaynakça

• 1. Iannuzzi J, Leung J, Quan J, Underwood F. Global incidence of acute pancreatitis through time: A aystematic review. J Can Assoc Gastroenterol 2019;2:499-501.
• 2. Xiao AY, Tan MLY, Wu LM, 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;1:45-55.
• 3. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis - 2012: Revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-11.
• 4. Singh VK, Bollen TL, Wu BU, et al. An Assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol 2011;9:1098-103.
• 5. Vege SS, Gardner TB, Chari ST, et al. Low mortality and high morbidity in severe acute pancreatitis without organ failure: A case for revising the Atlanta classification to include “moderately severe acute pancreatitis.” Am J Gastroenterol 2009;104:710-5.
• 6. Mofidi R, Duff MD, Wigmore SJ, et al. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg 2006;93:738-44.
• 7. De Bernardinis M, Violi V, Roncoroni L, et al. Discriminant power and information content of Ranson’s prognostic signs in acute pancreatitis: A meta-analytic study. Crit Care Med 1999;27:2272-83.
• 8. Gao W, Yang HX, Ma CE. The value of BISAP score for predicting mortality and severity in acute pancreatitis: A systematic review and meta-analysis. PLoS One 2015;10:e0130412.
• 9. Oskarsson V, Mehrabi M, Orsini N, et al. Validation of the harmless acute pancreatitis score in predicting nonsevere course of acute pancreatitis. Pancreatology 2011;11:464-8.
• 10. Hamada T, Yasunaga H, Nakai Y, et al. Japanese severity score for acute pancreatitis well predicts in-hospital mortality: A nationwide survey of 17,901 cases. J Gastroenterol 2013;48:1384-91.
• 11. Karabıyık L. Intensive care scoring systems. Yoğun Bakım Derg 2010;9:129-43.
• 12. Juneja D, Gopal PB, Ravula M. Scoring systems in acute pancreatitis: Which one to use in intensive care units? J Crit Care 2010;25:358.e9-358.e15.
• 13. Shi L, Zhang D, Zhang J. Albumin-bilirubin score is associated with in-hospital mortality in critically ill patients with acute pancreatitis. Eur J Gastroenterol Hepatol 2020;32:963-70
• 14. Suppiah A, Malde D, Arab T, et al. The prognostic value of the neutrophil-lymphocyte ratio (NLR) in acute pancreatitis: Identification of an optimal NLR. J Gastrointest Surg 2013;17:675-81.
• 15. Dias BH, Rozario AP, Olakkengil SA, et al. Procalcitonin strip test as an independent predictor in acute pancreatitis. Indian J Surg 2015;77:1012-7.
• 16. Svendsen K, Borchgrevink PC, Fredheim O, et al. Choosing the unit of measurement counts: The use of oral morphine equivalents in studies of opioid consumption is a useful addition to defined daily doses. Palliat Med 2011;25:725-32.
• 17. Imrie CW, Benjamin IS, Ferguson JC, et al. A single‐centre double‐blind trial of Trasylol therapy in primary acute pancreatitis. Br J Surg 1978;65:337-41.
• 18. Kiat TTJ, Gunasekaran SK, Junnarkar SP, et al. Are traditional scoring systems for severity stratification of acute pancreatitis sufficient? Ann Hepato-Biliary-Pancreatic Surg 2018;22:105-15.
• 19. Biberci Keskin E, Taşlıdere B, Koçhan K, et al. Comparison of scoring systems used in acute pancreatitis for predicting major adverse events. Gastroenterol Hepatol 2020;43:193-9.
• 20. Hong W, Lillemoe KD, Pan S, et al. Development and validation of a risk prediction score for severe acute pancreatitis. J Transl Med 2019;17:146.
• 21. Zhang J, Shahbaz M, Fang R, et al. Comparison of the BISAP scores for predicting the severity of acute pancreatitis in Chinese patients according to the latest Atlanta classification. J Hepatobiliary Pancreat Sci 2014;21:689-94.
• 22. Papachristou GI, Muddana V, Yadav D, et al. Comparison of BISAP, Ranson’s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol 2010;105:435-41.
• 23. Al-Qahtani HH, Alam MKh, Waheed M. Comparison of Harmless Acute Pancreatitis Score with Ranson’s Score in predicting the severity of acute pancreatitis. J Coll Physicians Surg Pak 2017;27:75-9.
• 24. Sayraç AV, Cete Y, Yiğit Ö, et al. Utility of HAPS for predicting prognosis in acute pancreatitis. Ulus Travma ve Acil Cerrahi Derg 2018;24:327-32.
• 25. Han C, Zeng J, Lin R, et al. The utility of neutrophil to lymphocyte ratio and fluid sequestration as an early predictor of severe acute pancreatitis. Sci Rep 2017;7:10704
• 26. Modrau IS, Floyd AK, Thorlacius-Ussing O. The clinical value of procalcitonin in early assessment of acute pancreatitis. Am J Gastroenterol 2005;100:1593-7.