Value of early admission scoring systems in predicting the severity and prognosis of acute pancreatitis

Objective To screen out the scoring system with the highest predictive value by analyzing the comprehensive scoring systems which can assess the severity and prognosis of acute pancreatitis in the early stage( within 24 hours) after admission. Methods A retrospective analysis was performed for the clinical data of 254 patients with acute pancreatitis who were admitted to Department of Gastroenterology,The Second Affiliated Hospital of Kunming Medical University,from September 2016 to September 2019,and they were divided into mild acute pancreatitis( MAP) group,moderate-severe acute pancreatitis( MSAP) group,and severe acute pancreatitis( SAP) group.The three groups were compared in terms of general data,comorbidities,and scores of early admission scoring systems,including BISAP score,SIRS score,MEWS score,PANC3 score,HAPS score,CTSI score,and SPS score,and these scoring systems were compared in terms of their value in predicting the severity and prognosis of acute pancreatitis. An analysis of variance was used for comparison of normally distributed continuous data between groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The receiver operating characteristic( ROC) curve was plotted and the area under the ROC curve( AUC) was compared. Results The SAP group had a significantly longer length of hospital stay and significantly higher hospital costs than the other two groups( H = 48. 82 and 76. 93,both P<0. 05). As for comorbidities,there were significant differences in the presence or absence of pulmonary infection,pancreatic necrosis,multiple organ dysfunction syndrome( MODS),and death between the three groups( H = 64. 84,98. 19,53. 09,and 8. 09,all P < 0. 05). As for the early scoring systems,there were significant differences between the three groups in BISAP score,SIRS score,MEWS score,HAPS score,CTSI score,and SPS score( H = 93. 19,21. 24,23. 99,16. 57,67. 09,and 33. 95,all P < 0. 05). The early scoring systems were further compared in terms of the severity of pancreatitis and complications based on the ROC curve,and it was found that BISAP score had the highest value in predicting SAP and pulmonary infection within 24 hours after admission,with sensitivities of 86. 10% and 51. 20%,respectively,and specificities of 81. 70% and 83. 50%,respectively,at the cut-off value of >2. CTSI score had the highest value in predicting pancreatic necrosis,with a sensitivity of 82. 70% and a specificity of 89. 10% at the cut-off value of > 3. In terms of MODS,both HAPS and BISAP scores had good predictive value,with sensitivities of 63. 70% and 75. 00%,respectively,and specificities of 90. 00%and 76. 10%,respectively. Conclusion Different scoring systems have their own advantages in predicting the severity and complications of pancreatitis in the early stage,among which BISAP score has a high value in predicting SAP,pancreatitis with pulmonary infection,and MODS,CTSI score has a high value in predicting pancreatic necrosis,and HAPS score has a high value in excluding MODS in the early stage.