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United European Gastroenterol J. 2017 Apr;5(3):389-397. doi: 10.1177/2050640616670566. Epub 2016 Sep 27.

Validation of the efficacy of the prognostic factor score in the Japanese severity criteria for severe acute pancreatitis: A large multicenter study.

Author information

1
Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan.
2
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
3
Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
4
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Saitama, Japan.
5
Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan.
6
Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan.
7
Department of Anesthesiology, Kansai Medical University, Osaka, Japan.
8
Department of Radiology, Kansai Medical University, Osaka, Japan.
9
Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Osaka, Japan.
10
Department of Anesthesiology and Intensive Care, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
11
Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
12
Department of General Internal Medicine, Iizuka Hospital, Fukuoka, Japan.
13
Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
14
Advanced Emergency Medical and Critical Care Center, Japanese Redcross Maebashi Hospital, Gunma, Japan.
15
Department of Emergency Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan.
16
Division of Gastroenterology, Showa University School of Medicine, Tokyo, Japan.
17
Department of Emergency and Critical Care Medicine, Nihon University Hospital, Tokyo, Japan.
18
Department of Acute Care and General Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
19
Emergency Medical Center, Fukuyama City Hospital, Hiroshima, Japan.
20
Division of Intensive Care, Jichi Medical University School of Medicine, Tochigi, Japan.
21
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
22
Department of Emergency and Critical Care Medicine, Osaka City University, Osaka, Japan.
23
Division of Gastroenterology, Tohoku University Hospital, Miyagi, Japan.
24
Department of Gastroenterology, Fujita Health University, Nagoya, Japan.
25
Department of Intensive Care Medicine, Asahi General Hospital, Chiba, Japan.
26
Department of Medicine, Shinshu University School of Medicine, Nagano, Japan.
27
Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.

Abstract

BACKGROUND:

The Japanese severity criteria for acute pancreatitis (AP), which consist of a prognostic factor score and contrast-enhanced computed tomography grade, have been widely used in Japan.

OBJECTIVE:

This large multicenter retrospective study was conducted to validate the predictive value of the prognostic factor score for mortality and complications in severe AP patients in comparison to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score.

METHODS:

Data of 1159 patients diagnosed with severe AP according to the Japanese severity criteria for AP were retrospectively collected in 44 institutions.

RESULTS:

The area under the curve (AUC) for the receiver-operating characteristic curve of the prognostic factor score for predicting mortality was 0.78 (95% confidence interval (CI), 0.74-0.82), whereas the AUC for the APACHE II score was 0.80 (95% CI, 0.76-0.83), respectively. There were no significant differences in the AUC for predicting mortality between two scoring systems. The AUCs of the prognostic factor scores for predicting the need for mechanical ventilation, the development of pancreatic infection, and severe AP according to the revised Atlanta classification were 0.84 (95% CI, 0.81-0.86), 0.73 (95% CI, 0.69-0.77), and 0.83 (95% CI, 0.81-0.86), respectively, which were significantly greater than the AUCs for the APACHE II score; 0.81 (95% CI, 0.78-0.83) for the need for mechanical ventilation (p = 0.03), 0.68 (95% CI, 0.63-0.72) for the development of pancreatic infection (p = 0.02), and 0.80 (95% CI, 0.77-0.82) for severe AP according to the revised Atlanta classification (p = 0.01).

CONCLUSION:

The prognostic factor score has an equivalent ability for predicting mortality compared with the APACHE II score. Regarding the ability for predicting the development of severe complications during the clinical course of AP, the prognostic factor score may be superior to the APACHE II score.

KEYWORDS:

Acute pancreatitis; diagnosis; mortality; prognostic factor score; severity criteria

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