Within the study period, 87% of all icu patients had all 12 physiologic measurements available. Acute pancreatitis is defined as an inflammatory process of the pancreas with possible peripancreatic tissue and multiple organ involvement which induces. Apache means acute physiology and chronic health evaluation. The ranson score is used to predict the severity of acute pancreatitis. Evaluation of the clinical usefulness of apache ii and saps systems in.
Evaluation of ct severity index, ranson and apache ii and. Data should be taken from the first 24 hours of the patients evaluation. Although most patients with acute pancreatitis have the mild form of the disease, about 2030% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Apacheii predicted 73% of pancreatic collections at 48 h, compared with 65% for ranson and 58% for imrie scores. Pdf apacheii score for assessment and monitoring of. Acute pancreatic severity can be stratified by scoring systems such as ransons score, bisap score, apacheii score, sofa score. Acute pancreatitis is a sudden inflammation of the pancreas. Our aim was to prospectively compare the accuracy of acute physiology and chronic health evaluation apache ii, bedside index of severity in acute pancreatitis bisap, ransons score and modified computed tomography severity index ctsi in predicting the severity of acute pancreatitis based on atlanta 2012 definitions in a tertiary care hospital in northern india. It consists of three parts, namely, acute physiologyscore,age,andchronichealth score. Moreover, in the first 48 hours an apache ii score 7 is more powerful. Acute pancreatitis the ap diagnosis was performed to the patients that had at least 2 of the 3 following criteria. Different scoring systems in acute alcoholic pancreatitis scielo. Pancreatitis is an uncommon disease characterized by inflammation of the pancreas.
It is applied within 24 hours of admission of a patient to an intensive care unit icu. Since apache ii was studied on patients newly admitted to the icu, it is not accurate when dealing with patients transferred from another unit or another hospital. The early prediction of the severity of an acute attack has important implications for management and timely intervention aim to assess the prognostic accuracy of ranson and apache ii and iii scoring systems in predicting the severity of acute pancreatitis methods one hundred fiftythree patients with acute pancreatitis 67. The objective of this study was to correlate the severity degree of the acute pancreatitis according to the ranson, apacheii criteria, and the determination of the serous hematocrit at the moment of admission, with the local pancreatic complications according to the tomographic balthazar criteria, in order to give a better prognosis value to. The ctsi is the sum of the scores obtained with the balthazar score and those obtained with the evaluation of pancreatic necrosis. The original apache score was first used in 1981 and scores for three patient factors that influence acute illness outcome preexisting disease, patient reserve, and severity of acute illness. In recent years, with the developing of living standard, hyperlipidemia becomes the second major reason of acute pancreatitis. Receiver operating characteristics roc curves for severe acute pancreatitis, icu admission, pancreatic necrosis and organ failure were plotted for ransons score, bisap, apache ii and modified ctsi, and predictive accuracy of each scoring system was measured by the area under roc curve auc with 95% confidence interval. An important consideration was the impossibility to correlate the tomographic finds with the serum concentration of reactive c proteins, which is considered. Comparison of ranson, apache ii and apache iii scoring. The worst measurement was defined as the measure that correlated. The auc for modified ctsi was consistently the highest for predicting severe acute pancreatitis 0. The apache score was first developed in 1981 by the american intensivist william knaus and his. In the most common inpatient problems in internal medicine, 2007.
Apache iv is the latest version, published in 2006. A ranson score 3 or an apache ii score 8 indicates severe pancreatitis. The bisap is a morerecent score than the older ransons criteria, and does not require data points from 48 hours into a patients hospital admission. Apache ii acute physiology and chronic health evaluation ii is a severityofdisease classification system knaus et al. Apache ii is a frequently used scoring system to assess severity of ap. The lancet hospital practice apacheii score for assessment and monitoring of acute pancreatitis michael larvin michaelj. But apache ii was poor in assessment of local complications. It is important to predict the severity and prognosis at early stage of hyperlipidemic acute pancreatitis hlap. Comparison of bisap, ransons, apacheii, and ctsi scores in predicting organ failure, complications, and mortality in. The apache ii severity of disease classification system has been examined prospectively in 160 patients with acute pancreatitis. It is a condition that arises suddenly and may be quite severe, although patients usually have a. A comparison of apache ii, bisap, ransons score and modified. Pdf the atlanta classification of acute pancreatitis. To assess the severity and to predict the outcome of acute pancreatitis using ransons scoring system and apache ii scoring system and ct severity.
Thoeni, md an international working group has modified the atlanta classification for acute pancreatitis to update the terminology and provide simple functional clinical and morphologic classifications. Overall, the apache ii score has been found variously to underestimate or overestimate death, especially in highrisk patients. Nafld fibrosis score reduce the need for liver biopsy by identifying patients with nonalcoholic fatty liver disease likely or unlikely to have advanced fibrosis meld score age above 12 years scoring system used to rank prioritize candidates for liver transplantation, including meldna used in the optn match system alcohol relapse risk after. The severity diagnosis in acute pancreatitis, the apache score popovici raluca, baldea corina university of oradea faculty of environmental protection, gen magheru, nr. Using clinical and simple laboratory data apache ii was able to provide useful discrimination between uncomplicated, complicated and fatal attacks within a few hours of admission. Hypothesis the 48hour apache acute physiology and chronic health evaluation ii score is a better predictor of pancreatic necrosis, organ failure, and mortality in patients with severe acute pancreatitis than the score at hospital admission design a retrospective analysis of 125 patients with acute pancreatitis setting a tertiary public teaching hospital. We compared the bisap, ranson, mctsi, and apache ii scoring system in predicting msap and sap, local complications, and mortality of hlap. Two scoring systems are commonly used to identify patients with severe pancreatitis who have an increased risk of complications. Combination of apache ii score and an obesity score apache o for the prediction of severe acute pancreatitis. Although designed for the calculation of mortality in an intensive care unit the apache score has high sensitivity for the prediction of complications of acute pancreatitis such as pancreatic necrosis and organ failure 3.
The score was derived in a general icu population and may be less precise when applied to specific populations such as liver failure or hiv patients. Online calculator for the acute physiology and chronic health evaluation apache ii to. Ctsi and two traditional clinical scoring systems including apache ii and ranson. Apache ii score of 9 or more is considered as severe pancreatitis. An apache ii score increasing in the first 48 hours is strongly predictive of severe acute pancreatitis, while an apache ii score decreasing in the first 48 hours predicts mild acute pancreatitis 30. The acute physiology and chronic health evaluation apache score 5 is probably the bestknown and most widely used score. Mcmahon university department of surgery, the general infirmary at leeds, great george street, leeds lsi 3ex, united kingdom the value of the acute physiology and chronic health enquiry apache ii score, the simplified acute physiology score, and. Apacheii score for assessment and monitoring of acute pancreatitis. Comparison of bisap, ranson, mctsi, and apache ii in. Severity scoring systems in the critically ill bja.
Risk stratification in emergency surgical patients. Only apacheii scores and detection of pancreatic collections necrosis, were. Apache score can be observed during the course of acute pancreatitis. Publications home of jama and the specialty journals of. The balthazar score is a subscore within the ct severity index ctsi for grading of acute pancreatitis. Combination of apacheii score and an obesity score apacheo for the prediction of severe acute pancreatitis. Many of the the early prognostic markers used were apache ii score. The disease is assumed as severe acute pancreatitis when the score is 3 or more. Bisap bedside index for severity in acute bisap, apache ii and balthazar scores were calculated.
Apache ii score 8 after 48 h uk 1998 158 refers to atlanta classi. Research article comparison of bisap, ranson, mctsi, and. Acute pancreatitis is classified based on revised atlanta classification 20 as mild, moderately severe and severe acute pancreatitis. The apache ii score is made of 12 physiological variables and 2 diseaserelated variables. The revised atlanta classification of acute pancreatitis. A comparison of apache ii, bisap, ransons score and. A comparative study of marshall score versus apacheii score in. The value of bisap score for predicting mortality and severity in acute pancreatitis. Conclusion apache ii emerged as most reliable scoring system followed by bisap and ranson in management of the patients with acute pancreatitis.
The diagnosis of severe acute pancreatitis should be made if the patient has a serum crp. Obesity increases the severity of acute pancreatitis. Its importance for the radiologist and its effect on treatment 1 ruedi f. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Introduction acute pancreatitis runs an unpredictable course. Infection of the pancreatic and peripancreatic necrosis occurs in about 2040% of. The apache ii score estimates icu mortality based on a number of laboratory values and patient signs taking both acute and chronic disease into account. Apacheii score for assessment and monitoring of acute pancreatitis article pdf available in the lancet 28656. The worst physiological variables were collected within the first 24 hours of icu admission.
Acute pancreatitis affects about 50,000 80,000 americans each year. Built on the study of a more recent patient population and standard of care, it has now become the recommended score to be used instead of apache ii and iii. Bisap score is observed during the first 24 hours of admission to predict mortality before the onset of organ failure. In acute pancreatitis, apacheii may facilitate after admission to hospital. Apache ii and chronic health evaluation apache ii score 8 points predicts 11% to 18% mortality. Ourstudyshowed that the apache ii had highest accuracy in predicting msap and sap and did a good job in predicting mortality. Between and, mortality from acute pancreatitis decrease. Apache ii score for assessment and monitoring of acute pancreatitis. Acute physiology and chronic health evaluation apache ii. Predicts mortality risk in pancreatitis with fewer variables than ransons. Apache ii score for assessment and monitoring of acute pancreatitis article pdf available in the lancet 28656.
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