Tan Yong Hui Alvin, Rafi Shumaila, Tyebally Fang Mirriam, Hwang Stephen, Lim Ee Wen, Ngu James, Tan Su-Ming
Department of Surgery, Changi General Hospital, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
ANZ J Surg. 2017 Sep;87(9):700-703. doi: 10.1111/ans.13139. Epub 2015 Apr 29.
The characteristics of patients with acute pancreatitis in multi-ethnic Singapore differ from that of the populations used in formulating the modified Ranson and Glasgow scores. The use of these scoring systems has not previously been validated in the Singaporean setting. This study aims to validate and compare the prognostic use of the modified Ranson and Glasgow scores, and to determine the superiority of one score over the other in predicting the outcome for acute pancreatitis in the Singaporean population.
This is a 3-year retrospective study of patients diagnosed with acute pancreatitis at our centre. Patients with chronic pancreatitis, acute on chronic pancreatitis, iatrogenic pancreatitis, pancreatic cancer as well as those with incomplete Ranson or Glasgow scores were excluded from the study. Case notes and computer records were reviewed for local complications of pancreatitis and organ failure. Receiver operator characteristic (ROC) curves of the Ranson and Glasgow scores were plotted for the prediction of severity and mortality.
Between January 2010 and December 2012, 230 cases were diagnosed with acute pancreatitis. A majority of the patients had mild pancreatitis (n = 194, 84.3%), and the overall 30-day mortality rate was 3.5% (n = 8). ROC of the Ranson and Glasgow scoring systems for mortality showed an area under curve (AUC) of 0.854 (P = 0.001) and 0.776 (P = 0.008), respectively. For severity, the AUC for the modified Ranson and Glasgow score was calculated to be 0.694 and 0.668, respectively.
The ROC curves of Ranson and Glasgow scores for mortality are comparable with that published in earlier studies. In a Singaporean population, the Ranson score is more accurate in the prediction of mortality. However, both scoring systems are poor predictors for severity of acute pancreatitis.
新加坡多民族人群中急性胰腺炎患者的特征与用于制定改良兰森和格拉斯哥评分的人群不同。此前这些评分系统在新加坡的应用尚未得到验证。本研究旨在验证和比较改良兰森和格拉斯哥评分在预后方面的应用，并确定在预测新加坡人群急性胰腺炎预后时一种评分相对于另一种评分的优越性。
这是一项对在我们中心被诊断为急性胰腺炎的患者进行的为期3年的回顾性研究。患有慢性胰腺炎、慢性胰腺炎急性发作、医源性胰腺炎、胰腺癌以及兰森或格拉斯哥评分不完整的患者被排除在研究之外。查阅病例记录和计算机记录，以了解胰腺炎的局部并发症和器官衰竭情况。绘制兰森和格拉斯哥评分的受试者工作特征（ROC）曲线，以预测严重程度和死亡率。
2010年1月至2012年12月期间，230例患者被诊断为急性胰腺炎。大多数患者为轻度胰腺炎（n = 194，84.3%），总体30天死亡率为3.5%（n = 8）。兰森和格拉斯哥评分系统用于死亡率预测的ROC曲线下面积（AUC）分别为0.854（P = 0.001）和0.776（P = 0.008）。对于严重程度，改良兰森和格拉斯哥评分的AUC分别计算为0.694和0.668。
兰森和格拉斯哥评分用于死亡率预测的ROC曲线与早期研究中发表的曲线相当。在新加坡人群中，兰森评分在预测死亡率方面更准确。然而，两种评分系统对于急性胰腺炎严重程度的预测都很差。
