Severity evaluation in acute pancreatitis: the role of SOFA score and general severity scores

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Introduction

Severity stratification in acute pancreatitis has long been a subject of debate. The availability of instruments specific for this pathologic condition lead some intensivists to argue for their use in this condition. However, to the best of our knowledge, no published study competed all these scores with general severity scores and organ failure scores on the same cohort. The objective of this work is to compare six disease-specific scores with two general severity scores (APACHE II and SAPS II) and one organ failure score (Sequential Organ Failure Assessment [SOFA] score) in patients admitted with acute pancreatitis to a mixed medical-surgical ICU.

Material and methods

We analysed all the patients discharged from the UCI from July 1 1991 to November 30 1999 with a diagnosis of acute pancreatitis. Basic demographic and clinical data were registered, as were outcome at ICU and hospital discharge as well as APACHE II, SAPS II, SOFA score (at admission, 24 h, 48 h and maximum during ICU stay), admission Ramson score, Ramson score at 48 h, Imrie score, Osborn score, Blamey score, Balthasar score, collected according to the original descriptions. Raw data necessary for the computation of the scores has been registered prospectively, using a proprietary computerised system.

The discriminative power of the scores was evaluated through the use of the area under the Receiver Operating Characteristics (ROC) curve. Two-sample student T-test was used for the comparison of survivors and nonsurvivors. The outcome measure used was vital status at hospital discharge.

Results

During the study period, 49 patients were discharged with a diagnosis of acute pancreatitis. Biliar tract disease (n=26) and alcoholism (n=8) where the most common aetiologies. In 13 patients no aetiology could be found. Mean age was 53.3± 16.6 years, lower in survivors than in nonsurvivors (45.3± 16.0 vs 63.1± 11.9, P<0.001). Median (interquartile range) length of stay in the ICU was 8.09 days (4.0 to 22.1 days), similar in survivors and non-survivors (P=NS). Mortality in the ICU was 34.7% (17 patients) with a corresponding hospital mortality of 44.9% (22 patients). Mean ± standard deviation in the global population, in survivors and in nonsurvivors are presented in the Table, together with the area under ROC curve± standard error for all the scores.

Conclusions

In this cohort of patients with acute pancreatitis, general severity scores and SOFA score presented a better discriminative capability than disease-specific scores, and the results support their use in risk stratification in these patients. If we take into account the lower work needed for the computation of the SOFA score, when compared to APACHE II and SAPS II, our results support the use of SOFA score, both at admission and latter during the ICU stay, for risk stratification in patients with acute pancreatitis.

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