Role of Scoring Systems in Prognosticating Outcomes of Patients With Acute Pancreatitis: A Prospective Cohort Study

Acute pancreatitis (AP) is a common cause of emergency hospital admissions, putting a substantial burden on the healthcare system. The clinical course of AP is usually mild and often resolves without a sequel. Severe AP (SAP) is associated with an intense inflammatory response leading to localized or systemic complications and significant morbidity and mortality (American Gastroenterological Association). Early diagnosis and precise assessment of disease severity are imperative during initial evaluation in patients with AP, as it has a bearing on deciding the course of management and prognosticating the disease outcome.

Eighty-six cases of AP treated in our institution between July 2022 and August 2024 were prospectively enrolled in the study. The patients underwent detailed clinical evaluation, and the Acute Physiology and Chronic Health Evaluation II (APACHE II), Bedside Index of Severity in Acute Pancreatitis (BISAP), and Ranson scores were calculated. Ranson was again calculated after 48 hours of admission. Contrast-enhanced computed tomography of the abdomen was done in all patients after 72 hours of the onset of pain, and a modified computed tomography severity index (mCTSI) was calculated. Data regarding patients was collected and correlated with the outcome.

During the course of the disease, seven (8.1%) patients died, while 79 (91.9%) improved. The majority of the patients, five of the seven patients (71.4%) who died, had SAP. On ROC curve analysis, Ranson was found to be the best predictor of SAP (area under the curve (AUC): 0.97), followed by APACHE II (AUC: 0.95), mCTSI (AUC: 0.95), and BISAP (AUC: 0.87). mCTSI was found to be the best predictor of pancreatic necrosis (AUC: 0.94), followed by Ranson (AUC: 0.87), APACHE-II (AUC: 0.78), and BISAP (AUC: 0.52). APACHE II had a slight edge over the rest of the scoring system in mortality predicting (APACHE II AUC: 0.72 95% CI (0.58-0.85), BISAP AUC: 0.67 95% CI (0.52-0.80), Ranson AUC: 0.68 95% CI (0.54-0.80), and mCTSI AUC: 0.72 95% CI (0.58-0.85)).

The ROC curve analysis demonstrated that Ranson was superior to the other scoring systems for predicting severity, and APACHE II had the highest accuracy for mortality.