Predictors of early outcome in severe acute pancreatitis:a comparative study of five scoring systems

objective To evaluate the prognostic value of five scoring systems including acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ ),Ranson score,sepsis-related organ failure assessment (SOFA),Balthazar CT severity index (CTSI) and modified early warning score (MEWS) in early prognosis of severe acute pancreatis.Methods One hundred and fifty-four patients with severe acute pancreatitis from January 2004 to January 2010 were studied retrospectively,and data pertinent to five scoring systems were recorded from day 1 to day 3 after admission in hospital All patients were divided into early non-survival group (43 cases) and early survival group ( 111 cases) by survival time after admission in hospital.Five scoring systems during first 3 days aftter admission and their prognostic value in early prognosis of severe acute pancreatitis was compared between two groups.Results Compared with that of early survival group,every day five scoring systems of early non-survival group were significantly higher in the first 3 days after admission (P ＜ 0.05 or ＜ 0.01 ).On day 1 after admission,APACHE Ⅱ was the most accurate predict of early mortality with area under curve (AUC) value of 0.879,closely followed by MEWS (AUC 0.858).On day 2 and 3 after admission,the MEWS was the most accurate predict of early mortality with AUC 0.900 and 0.942,respectively.Conclusion MEWS is more accurate predict of early mortality in severe acute pancreatitis among different scoring systems,worthy of generalization in clinic. Key words: Pancreatitis;  Prognosis;  Scoring system