A clinical study of various diagnostic criteria in evaluation of severity of acute pancreatitis

AUTHOR(s) : Agarwala Nishit, Das Smita, Bhuyan K
DOI No. : 10.31741/ijhrmlp.v5.i2.2019.12

ABSTRACT :
Acute Pancreatitis with rapidly progressive severe inflammatory response is associated with significant morbidity. Early assessment of severity and identification of patients at risk is important for early intensive therapy and timely intervention. The study was taken up to see the applicability of various diagnostic criteria in the evaluation of the severity of acute pancreatitis. Materials and methods: The prospective clinical study was carried out amongst the patients admitted with Acute Pancreatitis in a tertiary care hospital in Assam for a period of one year. Data was collected by predesigned and pretested schedule along with the clinical examination and laboratory investigations. Revised Atlanta classification, 2012 of determination of the severity of AP was taken as the gold standard and accordingly Ranson, APACHE II, and BISAP score was calculated for severity assessment. The first outcome recorded with the accuracy in the determination of the severity of Acute Pancreatitis. The final outcome was recorded as per the eventuality of the treatment course. Statistical analysis of categorical values was evaluated using the Chi-square or Fischer extract test. Results: The average RANSON score of severe patients was 3.94. The sensitivity of RANSON’S scoring system was 75% while it had 84.21% specificity in predicting severe acute pancreatitis. The average BISAP score of severe patients was 2.36. The sensitivity of the BISAP scoring system was 75%, while it had 86.84% specificity in predicting severe acute pancreatitis. The average APACHE II score of the severe patients was 10.34 with a sensitivity of 83.34% and specificity of 86.84% The APACHE II score has demonstrated the highest accuracy for the prediction of severe AP (AUC = 0.910, 95% CI: 0.826-0.993). Conclusions: APACHE II score was found to be a better predictor of disease severity and survivability with good sensitivity and high specificity.

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