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Table of Contents
LETTER TO THE EDITOR
Year : 2016  |  Volume : 6  |  Issue : 3  |  Page : 155-156

Severe acute biliary pancreatitis requiring intensive care unit admission: Evaluation of severity score for the prediction of morbidity and mortality


1 ICU, Tahar Sfar University Hospital, Mahdia-, Tunisia
2 ICU, Habib Bourguiba University Hospital - 3029, Sfax, Tunisia

Date of Web Publication16-Sep-2016

Correspondence Address:
Mabrouk Bahloul
ICU Habib Bourguiba University Hospital-3029 Sfax
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.190653

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How to cite this article:
Majdoub A, Bahloul M, Ouaz M, Chtara K, Msakni Y, Regaieg K, Bouaziz M, Haddad B. Severe acute biliary pancreatitis requiring intensive care unit admission: Evaluation of severity score for the prediction of morbidity and mortality. Int J Crit Illn Inj Sci 2016;6:155-6

How to cite this URL:
Majdoub A, Bahloul M, Ouaz M, Chtara K, Msakni Y, Regaieg K, Bouaziz M, Haddad B. Severe acute biliary pancreatitis requiring intensive care unit admission: Evaluation of severity score for the prediction of morbidity and mortality. Int J Crit Illn Inj Sci [serial online] 2016 [cited 2020 Oct 28];6:155-6. Available from: https://www.ijciis.org/text.asp?2016/6/3/155/190653

Dear Editor,

Acute pancreatitis (AP) is a sudden inflammation of the pancreas. AP is a common presentation in emergency department (ED). It can have severe complications and high mortality despite treatment. Severe cases may require admission to Intensive Care Unit.[1],[2]

Severity of pancreatitis is an important consideration for ED clinicians making admission judgments. The early identification of severe AP is important for the management and for improving outcomes. Validated scoring systems can be a helpful tool in this process. A multitude of predictive models has been developed to predict the severity of AP based on clinical, laboratory, and radiologic risk factors, various severity grading systems, and serum markers. This study aimed to evaluate the comparative usefulness of the Acute Physiology and Chronic Health Evaluation-II (APACHE-II),[1] computed tomography imaging scoring systems (CTSI) score,[1] Bedside Index of Severity in Acute Pancreatitis (BISAP) score,[1],[2] Ranson score,[3] and IMIRIE score [3] to predict the prediction the morbidity and mortality in acute severe biliary pancreatitis requiring Intensive Care Unit admission.

During the study period, 49 patients were admitted to our ICU for acute biliary pancreatitis. The mean age was 62 ± 18 years and the sex ratio (M/F) was at 0.96. The mean value of the Ranson score was 3 ± 2 with a range of 0–7. The mean value of the BISAP score was 2 ± 1 with a range of 0–4. The mean value of the IMRIE score was 3 ± 1 with a range of 0–6. The mean value of the APACHE-II score was 14 ± 6 ranging from 4 to 32 points. The mean value of the CTSI index was 3 ± 2 with a range of 0–8. For predicting respiratory failure, the APACHE-II score was more predictive with specificity of 70.3%, sensitivity of 83.3%, and area under ROC curve of 0.83. For predicting circulatory failure, the APACHE-II score was more predictive with specificity of 92%, sensitivity of 71.4%, and area under ROC curve of 0.87. For predicting poor outcome (death), the APACHE-II score was more predictive with specificity of 97.5%, sensitivity of 87.5%, and area under ROC curve of 0.96 [Figure 1].
Figure 1: Receiver-operating curves of BISAP, Ranson, IMRIE, APACHE-II, and CTSI scores to predict outcome (death) (BISAP: Area under the curve = 0.80; Ranson: Area under the curve = 0.75; IMRIE: Area under the curve = 0.63; APACHE-II: Area under the curve = 0. 96; CTSI: Area under the curve = 0.62). APACHE-II: Acute Physiology and Chronic Health Evaluation-II, CTSI: Computed tomography imaging scoring system, BISAP: Bedside Index of Severity in Acute Pancreatitis

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APACHE-II score consists of 12 physiological parameters and evaluates the severity of the disease. It was designed to predict mortality in Intensive Care Units. Current practice guidelines have suggested that APACHE-II score was the most helpful test at admission in distinguishing severe from mild AP, and according to recommendation, it should be generated during the first 3 days of hospitalization.[4] Larvin et al.[5] predicted that the sensitivity and specificity of APACHE-II scoring were superior to Ranson and Glasgow scoring because it can successively monitor therapeutic response and prognostic evaluation in patients with AP. In this study, APACHE-II score appeared to be a more influential tool than other scoring systems to evaluate the mortality and morbidity.

We concluded that APACHE-II score appeared to be a more influential tool than other scoring systems to evaluate the mortality and morbidity in patients with severe acute biliary pancreatitis requiring Intensive Care Unit admission. However, we must mention that our study has some limitations. The major limitation is the sample size. However, this can be explained by the short study period in a single center. Moreover, it included only patients with biliary pancreatitis to study the usefulness of five severity scores to predict the morbidity and mortality in this specific condition. The retrospective design of our study represents a methodological limitation. However, the same methodology was used in several studies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kuo DC, Rider AC, Estrada P, Kim D, Pillow MT. Acute pancreatitis: What's the score? J Emerg Med 2015;48:762-70.  Back to cited text no. 1
    
2.
Fagenholz PJ, Fernández-del Castillo C, Harris NS, Pelletier AJ, Camargo CA Jr. Direct medical costs of acute pancreatitis hospitalizations in the United States. Pancreas 2007;35:302-7.  Back to cited text no. 2
    
3.
Suzuki M, Saito N, Naritaka N, Nakano S, Minowa K, Honda Y, et al. Scoring system for the prediction of severe acute pancreatitis in children. Pediatr Int 2015;57:113-8.  Back to cited text no. 3
    
4.
Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006;101:2379-400.  Back to cited text no. 4
    
5.
Larvin M, McMahon MJ. APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet 1989;2:201-5.  Back to cited text no. 5
    


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