Development of a Scoring System For Severe Acute Pancreatitis And Utility of US-guided Catheter Drainage in High-risk...

Severe acute pancreatitis (SAP) carries a high mortality rate. This study aimed to develop a rapid scoring system using admission laboratory parameters to predict mortality in SAP and to evaluate whether high-risk patients identified by this score benefit from ultrasound-guided percutaneous catheter drainage (PCD).

In this retrospective study, 469 SAP patients (304 conservative, 165 PCD) from January 2015 to March 2023 were included. After propensity score matching for age, sex, and etiology, 316 well-balanced patients (158 per group) were analyzed. A scoring system was developed from the conservative cohort using multivariate logistic regression, with mortality as the primary outcome.

A scoring system was created comprising procalcitonin >1.195 ng/ml (1 point), RBC <3.61×10¹²/L (1 point), WBC >20.2×10⁹/L (2 points), and platelet <149×10⁹/L (1 point). A cutoff of ≥3 points predicted mortality with an AUC of 0.965. Among high-risk patients (score≥3), mortality was significantly lower in the PCD group than in the conservative group (20.6% vs. 57.1%, p=0.006). Furthermore, PCD performed within two weeks of onset was associated with lower mortality than later intervention (9.5% vs. 22.2%, p=0.026).

The proposed scoring system effectively identifies high-risk SAP patients who may obtain a substantial survival benefit from early PCD intervention.