Comparison of Existing Clinical Scoring Systems to Predict Persistent Organ Failure in Patients With Acute Pancreatitis
Mounzer R et al. – The existing scoring systems seem to have reached their maximal efficacy in predicting persistent organ failure in acute pancreatitis. Sophisticated combinations of predictive rules are more accurate but cumbersome to use, and therefore of limited clinical use. The ability to predict the severity of acute pancreatitis cannot be expected to improve unless the authors develop new approaches.Methods
- Clinical data from 2 prospective cohorts were used for training (n=256) and validation (n=397).
- Persistent organ failure was defined as cardiovascular, pulmonary, and/or renal failure that lasted for 48 hours or more.
- Nine clinical scores were calculated when patients were admitted and 48 hours later.
- The authors developed 12 predictive rules that combined these scores, in order of increasing complexity.
- Existing scoring systems showed modest accuracy (areas under the curve at admission of 0.62–0.84 in the training cohort and 0.57–0.74 in the validation cohort).
- The Glasgow score was the best classifier at admission in both cohorts.
- Serum levels of creatinine and blood urea nitrogen provided similar levels of discrimination in each set of patients.
- The 12 predictive rules increased accuracy to 0.92 in the training cohort and 0.84 in the validation cohort.