The harmless acute pancreatitis score (HAPS) identifies non-severe patients: A systematic review and meta-analysis.

INTRODUCTION

We previously described a scoring system to identify patients with harmless acute pancreatitis as defined by absence of pancreatic necrosis, no need for artificial ventilation or dialysis, and non-fatal course. This scoring system, the Harmless Acute Pancreatitis Score (HAPS), can be quickly calculated from three parameters: absence of abdominal tenderness or rebound, normal hematocrit and normal creatinine level. We aim to assess the positive predictive value (PPV) of the HAPS by performing a meta-analysis of subsequently published studies.

METHODS

We performed a literature search using Pubmed, Web of Science and Google Scholar. We used random effects models, with maximum likelihood estimates, to estimate the PPV of HAPS. We produced forest plots and used the I statistic to quantify heterogeneity.

RESULTS

Twenty reports covering 6374 patients were identified. The overall PPV based on 16 studies that closely followed the original description of the HAPS system was 97% (95%CI 95-99%) with significant heterogeneity (I = 76%; P < 0.01). For 11 studies in which HAPS was used to identify patients with mild AP, the overall PPV dropped to 83% (74-91%). For 8 studies in which HAPS was used to predict non-fatal course the overall PPV was 98% (97-100%).

CONCLUSION

The HAPS, if used as originally defined, accurately identifies patients with non-severe AP who will not require ICU care and facilitate selection of patients who can be discharged after a short stay on a general ward or can even be cared for at home. This could free hospital beds for other purposes and decrease healthcare costs.