Conclusion apache ii emerged as most reliable scoring system followed by bisap and ranson in management of the patients with acute pancreatitis. The ctsi is the sum of the scores obtained with the balthazar score and those obtained with the evaluation of pancreatic necrosis. Apache means acute physiology and chronic health evaluation. Bisap score is observed during the first 24 hours of admission to predict mortality before the onset of organ failure. Thoeni, md an international working group has modified the atlanta classification for acute pancreatitis to update the terminology and provide simple functional clinical and morphologic classifications. It is applied within 24 hours of admission of a patient to an intensive care unit icu.
The apache ii score estimates icu mortality based on a number of laboratory values and patient signs taking both acute and chronic disease into account. Pdf apacheii score for assessment and monitoring of. The early prediction of the severity of an acute attack has important implications for management and timely intervention aim to assess the prognostic accuracy of ranson and apache ii and iii scoring systems in predicting the severity of acute pancreatitis methods one hundred fiftythree patients with acute pancreatitis 67. Hypothesis the 48hour apache acute physiology and chronic health evaluation ii score is a better predictor of pancreatic necrosis, organ failure, and mortality in patients with severe acute pancreatitis than the score at hospital admission design a retrospective analysis of 125 patients with acute pancreatitis setting a tertiary public teaching hospital. Predicts mortality risk in pancreatitis with fewer variables than ransons. Apache iv is the latest version, published in 2006. The worst measurement was defined as the measure that correlated. The value of bisap score for predicting mortality and severity in acute pancreatitis.
Its importance for the radiologist and its effect on treatment 1 ruedi f. Apache ii is a frequently used scoring system to assess severity of ap. The bisap is a morerecent score than the older ransons criteria, and does not require data points from 48 hours into a patients hospital admission. The lancet hospital practice apacheii score for assessment and monitoring of acute pancreatitis michael larvin michaelj. Evaluation of ct severity index, ranson and apache ii and. Pancreatitis is an uncommon disease characterized by inflammation of the pancreas. It is a condition that arises suddenly and may be quite severe, although patients usually have a. Apacheii score for assessment and monitoring of acute pancreatitis. Acute pancreatitis is defined as an inflammatory process of the pancreas with possible peripancreatic tissue and multiple organ involvement which induces. The revised atlanta classification of acute pancreatitis.
To assess the severity and to predict the outcome of acute pancreatitis using ransons scoring system and apache ii scoring system and ct severity. In recent years, with the developing of living standard, hyperlipidemia becomes the second major reason of acute pancreatitis. It consists of three parts, namely, acute physiologyscore,age,andchronichealth score. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Within the study period, 87% of all icu patients had all 12 physiologic measurements available. The apache score was first developed in 1981 by the american intensivist william knaus and his. Combination of apacheii score and an obesity score apacheo for the prediction of severe acute pancreatitis. Two scoring systems are commonly used to identify patients with severe pancreatitis who have an increased risk of complications. Infection of the pancreatic and peripancreatic necrosis occurs in about 2040% of. Evaluation of the clinical usefulness of apache ii and saps systems in. Receiver operating characteristics roc curves for severe acute pancreatitis, icu admission, pancreatic necrosis and organ failure were plotted for ransons score, bisap, apache ii and modified ctsi, and predictive accuracy of each scoring system was measured by the area under roc curve auc with 95% confidence interval. Between and, mortality from acute pancreatitis decrease. Comparison of ranson, apache ii and apache iii scoring. An apache ii score increasing in the first 48 hours is strongly predictive of severe acute pancreatitis, while an apache ii score decreasing in the first 48 hours predicts mild acute pancreatitis 30.
In the most common inpatient problems in internal medicine, 2007. Although most patients with acute pancreatitis have the mild form of the disease, about 2030% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Mcmahon university department of surgery, the general infirmary at leeds, great george street, leeds lsi 3ex, united kingdom the value of the acute physiology and chronic health enquiry apache ii score, the simplified acute physiology score, and. The acute physiology and chronic health evaluation apache score 5 is probably the bestknown and most widely used score.
Introduction acute pancreatitis runs an unpredictable course. But apache ii was poor in assessment of local complications. Comparison of bisap, ransons, apacheii, and ctsi scores in predicting organ failure, complications, and mortality in. Apache ii score 8 after 48 h uk 1998 158 refers to atlanta classi. Ourstudyshowed that the apache ii had highest accuracy in predicting msap and sap and did a good job in predicting mortality.
Risk stratification in emergency surgical patients. Acute pancreatitis is a sudden inflammation of the pancreas. Publications home of jama and the specialty journals of. The worst physiological variables were collected within the first 24 hours of icu admission. Apache ii score for assessment and monitoring of acute pancreatitis article pdf available in the lancet 28656. Pdf the atlanta classification of acute pancreatitis. In acute pancreatitis, apacheii may facilitate after admission to hospital. Apacheii score for assessment and monitoring of acute pancreatitis article pdf available in the lancet 28656. Since apache ii was studied on patients newly admitted to the icu, it is not accurate when dealing with patients transferred from another unit or another hospital. Ctsi and two traditional clinical scoring systems including apache ii and ranson. It is important to predict the severity and prognosis at early stage of hyperlipidemic acute pancreatitis hlap. A comparison of apache ii, bisap, ransons score and. Although designed for the calculation of mortality in an intensive care unit the apache score has high sensitivity for the prediction of complications of acute pancreatitis such as pancreatic necrosis and organ failure 3.
Bisap bedside index for severity in acute bisap, apache ii and balthazar scores were calculated. An important consideration was the impossibility to correlate the tomographic finds with the serum concentration of reactive c proteins, which is considered. Acute pancreatitis is classified based on revised atlanta classification 20 as mild, moderately severe and severe acute pancreatitis. Acute pancreatic severity can be stratified by scoring systems such as ransons score, bisap score, apacheii score, sofa score. The score was derived in a general icu population and may be less precise when applied to specific populations such as liver failure or hiv patients. Acute physiology and chronic health evaluation apache ii. The ranson score is used to predict the severity of acute pancreatitis. The disease is assumed as severe acute pancreatitis when the score is 3 or more. A ranson score 3 or an apache ii score 8 indicates severe pancreatitis.
A comparative study of marshall score versus apacheii score in. Comparison of bisap, ranson, mctsi, and apache ii in. Obesity increases the severity of acute pancreatitis. The original apache score was first used in 1981 and scores for three patient factors that influence acute illness outcome preexisting disease, patient reserve, and severity of acute illness. A comparison of apache ii, bisap, ransons score and modified. Acute pancreatitis affects about 50,000 80,000 americans each year. Apache ii and chronic health evaluation apache ii score 8 points predicts 11% to 18% mortality. Apache ii score for assessment and monitoring of acute pancreatitis. Online calculator for the acute physiology and chronic health evaluation apache ii to. Combination of apache ii score and an obesity score apache o for the prediction of severe acute pancreatitis. The auc for modified ctsi was consistently the highest for predicting severe acute pancreatitis 0. Apacheii predicted 73% of pancreatic collections at 48 h, compared with 65% for ranson and 58% for imrie scores. Only apacheii scores and detection of pancreatic collections necrosis, were.
We compared the bisap, ranson, mctsi, and apache ii scoring system in predicting msap and sap, local complications, and mortality of hlap. Moreover, in the first 48 hours an apache ii score 7 is more powerful. The balthazar score is a subscore within the ct severity index ctsi for grading of acute pancreatitis. The apache ii score is made of 12 physiological variables and 2 diseaserelated variables.
Using clinical and simple laboratory data apache ii was able to provide useful discrimination between uncomplicated, complicated and fatal attacks within a few hours of admission. Many of the the early prognostic markers used were apache ii score. The apache ii severity of disease classification system has been examined prospectively in 160 patients with acute pancreatitis. Apache ii acute physiology and chronic health evaluation ii is a severityofdisease classification system knaus et al. Data should be taken from the first 24 hours of the patients evaluation. Overall, the apache ii score has been found variously to underestimate or overestimate death, especially in highrisk patients. The objective of this study was to correlate the severity degree of the acute pancreatitis according to the ranson, apacheii criteria, and the determination of the serous hematocrit at the moment of admission, with the local pancreatic complications according to the tomographic balthazar criteria, in order to give a better prognosis value to.