Wang An-jiang, Xu Si, Hong Jun-bo, Liu Pi, Xia Liang, Zhu Yin, He Wen-hua, Chen You-xiang, Lü Nong-hua
Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China. Email:
Zhonghua Nei Ke Za Zhi. 2013 Aug;52(8):668-71.
To compare the predictive value of BISAP (bedside index for severity in acute pancreatitis), APACHE II (acute physiology and chronic health evaluation II), and Ranson scoring system in persistent organ failure (POF) and mortality in patients diagnosed as acute pancreatitis (AP) based on the revised Atlanta classification.
Demographic, clinical and laboratory data of 350 consecutive AP patients admitted to the First Affiliated Hospital of Nanchang University were prospectively collected from November, 2009 to January, 2012. A retrospective analysis was performed and 310 patients finished the follow-up. The median age of whole population was (50.5 ± 16.4) years old. Patients were classified into early phase group ( ≤ 7 days) and late phase group ( > 7 days) based on the interval between onset of AP and admission. Demographics and clinical data were collected to calculate Ranson, APACHE II and BISAP scores during the first 3 days of hospitalization. Poor prognosis was defined as POF or death.
The three scoring systems similarly demonstrated modest accuracy for predicting POF or death in early phase group [area under the receiver operating characteristic curve (AUCROC):0.68-0.84], but failed to predict the prognosis of AP patients in late phase group. Daily scoring of APACHE IIand BISAP on the first 3 days after admission demonstrated modest to high predictive accuracy to poor prognosis (AUCROC:0.69-0.95), but this was not statistically significant (P > 0.05) .
These three clinical scoring systems show modest accuracy for predicting POF or death in AP patients on the early phase based on the revised Atlanta classification. The BISAP scoring system has similar prognostic value to APACHE II and Ranson. However, due to the simplicity and convenience, BISAP scoring system is more popular in clinical practice. Daily scoring on the first 3 days after admission fails to predict the prognosis accurately.
基于修订后的亚特兰大分类法，比较BISAP（急性胰腺炎严重程度床边指数）、APACHE II（急性生理与慢性健康状况评估II）和兰森评分系统对诊断为急性胰腺炎（AP）患者持续性器官衰竭（POF）及死亡率的预测价值。
前瞻性收集2009年11月至2012年1月南昌大学第一附属医院连续收治的350例AP患者的人口统计学、临床及实验室数据。进行回顾性分析，310例患者完成随访。总体人群中位年龄为（50.5±16.4）岁。根据AP发病至入院间隔时间，将患者分为早期组（≤7天）和晚期组（>7天）。收集人口统计学和临床数据，计算住院前3天的兰森、APACHE II和BISAP评分。预后不良定义为POF或死亡。
三种评分系统在早期组预测POF或死亡的准确性相近[受试者工作特征曲线下面积（AUCROC）：0.68 - 0.84]，但未能预测晚期组AP患者的预后。入院后前3天对APACHE II和BISAP进行每日评分，对预后不良的预测准确性为中等至高（AUCROC：0.69 - 0.95），但差异无统计学意义（P>0.05）。
基于修订后的亚特兰大分类法，这三种临床评分系统对AP患者早期POF或死亡的预测准确性中等。BISAP评分系统与APACHE II和兰森具有相似的预后价值。然而，由于简单方便，BISAP评分系统在临床实践中更受欢迎。入院后前3天的每日评分不能准确预测预后。
