The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Zhejiang University of Medicine, Hangzhou, Zhejiang, China.
PLoS One. 2024 Apr 30;19(4):e0302046. doi: 10.1371/journal.pone.0302046. eCollection 2024.
To systematically assess and compare the predictive value of the Ranson and Bedside Index of Severity in Acute Pancreatitis (BISAP) scoring systems for the severity and prognosis of acute pancreatitis (AP).
PubMed, Embase, Cochrane Library, and Web of Science were systematically searched until February 15, 2023. Outcomes in this analysis included severity and prognosis [mortality, organ failure, pancreatic necrosis, and intensive care unit (ICU) admission]. The revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to evaluate the quality of diagnostic accuracy studies. The threshold effect was evaluated for each outcome. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic (SROC) curve (AUC) as well as 95% confidence intervals (CI) were calculated. The DeLong test was used for AUC comparisons. For the outcome evaluated by over 9 studies, publication bias was assessed using the Deeks' funnel plot asymmetry test.
Totally 17 studies of 5476 AP patients were included. For severity, the pooled sensitivity of the Ranson and BISAP was 0.95 (95%CI: 0.87, 0.98) and 0.67 (95%CI: 0.27, 0.92); the pooled specificity of the Ranson and BISAP was 0.74 (0.52, 0.88) and 0.95 (95%CI: 0.85, 0.98); the pooled AUC of the Ranson and BISAP was 0.95 (95%CI: 0.93, 0.97) and 0.94 (95%CI: 0.92, 0.96) (P = 0.480). For mortality, the pooled sensitivity of the Ranson and BISAP was 0.89 (95%CI: 0.73, 0.96) and 0.77 (95%CI: 0.58, 0.89); the pooled specificity of the Ranson and BISAP was 0.79 (95%CI: 0.68, 0.87) and 0.90 (95%CI: 0.86, 0.93); the pooled AUC of the Ranson and BISAP was 0.91 (95%CI: 0.88, 0.93) and 0.92 (95%CI: 0.90, 0.94) (P = 0.480). For organ failure, the pooled sensitivity of the Ranson and BISAP was 0.84 (95%CI: 0.76, 0.90) and 0.78 (95%CI: 0.60, 0.90); the pooled specificity of the Ranson and BISAP was 0.84 (95%CI: 0.63, 0.94) and 0.90 (95%CI: 0.72, 0.97); the pooled AUC of the Ranson and BISAP was 0.86 (95%CI: 0.82, 0.88) and 0.90 (95%CI: 0.87, 0.93) (P = 0.110). For pancreatic necrosis, the pooled sensitivity of the Ranson and BISAP was 0.63 (95%CI: 0.35, 0.84) and 0.63 (95%CI: 0.23, 0.90); the pooled specificity of the Ranson and BISAP was 0.90 (95%CI: 0.77, 0.96) and 0.93 (95%CI: 0.89, 0.96); the pooled AUC of the Ranson and BISAP was 0.87 (95%CI: 0.84, 0.90) and 0.93 (95%CI: 0.91, 0.95) (P = 0.001). For ICU admission, the pooled sensitivity of the Ranson and BISAP was 0.86 (95%CI: 0.77, 0.92) and 0.63 (95%CI: 0.52, 0.73); the pooled specificity of the Ranson and BISAP was 0.58 (95%CI: 0.55, 0.61) and 0.84 (95%CI: 0.81, 0.86); the pooled AUC of the Ranson and BISAP was 0.92 (95%CI: 0.81, 1.00) and 0.86 (95%CI: 0.67, 1.00) (P = 0.592).
The Ranson score was an applicable tool for predicting severity and prognosis of AP patients with reliable diagnostic accuracy in resource and time-limited settings. Future large-scale studies are needed to verify the findings.
系统评估和比较 Ranson 和急性胰腺炎床边严重指数（BISAP）评分系统对急性胰腺炎（AP）严重程度和预后的预测价值。
系统检索 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库，检索时间截至 2023 年 2 月 15 日。本分析中的结局包括严重程度和预后[死亡率、器官衰竭、胰腺坏死和重症监护病房（ICU）入院]。使用修订后的诊断准确性研究质量评估工具（QUADAS-2）评估诊断准确性研究的质量。评估了每个结局的阈值效应。计算灵敏度、特异性、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）以及汇总受试者工作特征（SROC）曲线下面积（AUC）及其 95%置信区间（CI）。使用 DeLong 检验进行 AUC 比较。对于评估的结局超过 9 项研究，使用 Deeks 漏斗图不对称检验评估发表偏倚。
共纳入 5476 例 AP 患者的 17 项研究。严重程度方面，Ranson 和 BISAP 的合并敏感性分别为 0.95（95%CI：0.87，0.98）和 0.67（95%CI：0.27，0.92）；Ranson 和 BISAP 的合并特异性分别为 0.74（95%CI：0.52，0.88）和 0.95（95%CI：0.85，0.98）；Ranson 和 BISAP 的 SROC 曲线下面积分别为 0.95（95%CI：0.93，0.97）和 0.94（95%CI：0.92，0.96）（P=0.480）。死亡率方面，Ranson 和 BISAP 的合并敏感性分别为 0.89（95%CI：0.73，0.96）和 0.77（95%CI：0.58，0.89）；Ranson 和 BISAP 的合并特异性分别为 0.79（95%CI：0.68，0.87）和 0.90（95%CI：0.86，0.93）；Ranson 和 BISAP 的 SROC 曲线下面积分别为 0.91（95%CI：0.88，0.93）和 0.92（95%CI：0.90，0.94）（P=0.480）。器官衰竭方面，Ranson 和 BISAP 的合并敏感性分别为 0.84（95%CI：0.76，0.90）和 0.78（95%CI：0.60，0.90）；Ranson 和 BISAP 的合并特异性分别为 0.84（95%CI：0.63，0.94）和 0.90（95%CI：0.72，0.97）；Ranson 和 BISAP 的 SROC 曲线下面积分别为 0.86（95%CI：0.82，0.88）和 0.90（95%CI：0.87，0.93）（P=0.110）。胰腺坏死方面，Ranson 和 BISAP 的合并敏感性分别为 0.63（95%CI：0.35，0.84）和 0.63（95%CI：0.23，0.90）；Ranson 和 BISAP 的合并特异性分别为 0.90（95%CI：0.77，0.96）和 0.93（95%CI：0.89，0.96）；Ranson 和 BISAP 的 SROC 曲线下面积分别为 0.87（95%CI：0.84，0.90）和 0.93（95%CI：0.91，0.95）（P=0.001）。ICU 入院方面，Ranson 和 BISAP 的合并敏感性分别为 0.86（95%CI：0.77，0.92）和 0.63（95%CI：0.52，0.73）；Ranson 和 BISAP 的合并特异性分别为 0.58（95%CI：0.55，0.61）和 0.84（95%CI：0.81，0.86）；Ranson 和 BISAP 的 SROC 曲线下面积分别为 0.92（95%CI：0.81，1.00）和 0.86（95%CI：0.67，1.00）（P=0.592）。
Ranson 评分是一种适用于预测 AP 患者严重程度和预后的工具，在资源和时间有限的情况下具有可靠的诊断准确性。需要进一步开展大规模研究来验证这些发现。
