Comparative assessment of severity and prognosis of acute pancreatitis through APACHE II and HAPS predictor models

Background: Acute pancreatitis is one of the leading causes of hospitalization amongst all gastrointestinal disorders with high burden of morbidity and mortality. Predicting the progression of AP in terms of course and outcome to determine suitable management strategy and level of care is challenging. A number of predictor models are developed to predict the severity of acute pancreatitis but they vary in their definitions of severity. HAPS have been proposed as a simple scoring tool for assessment of severity and prognosis of acute pancreatitis. Thus, the aim of present study was to investigate the usefulness of HAPS predictor model against APACHE II model.Methods: Current investigation was a hospital based prospective study conducted on 80 proven cases of acute pancreatitis at K. K. hospital, Uttar Pradesh. The serum amylase and lipase levels of all enrolled patients, were tested and measured at admission, and at 48 and 72 hours post admission. The pancreatitis-specific clinical investigations like; HAPS, APACHE II were calculated and assessed statistically in terms of sensitivity, specificity, positive and negative predictive values and accuracy.Results: The findings of present investigation revealed that amongst the two scoring systems, APACHE II was superior predictor model in terms of sensitivity and specificity for various outcomes like severe acute pancreatitis, hospital stay >7 days and in-hospital mortality. However, HAPS exhibited high specificity for all the outcomes.Conclusions: HAPS can be recommended as a useful tool for early evaluation of acute pancreatitis in patients specifically in primary care settings of developing countries like India.

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The Role of Modified Early Warning Score (MEWS) in the Prognosis of Acute Pancreatitis

Oman Medical Journal ◽

10.5001/omj.2021.72 ◽

2021 ◽

Vol 36 (3) ◽

pp. e272-e272

Author(s):

Amena Khan ◽

Digvijoy Sarma ◽

Chiranth Gowda ◽

Gabriel Rodrigues

Keyword(s):

Acute Pancreatitis ◽

Early Warning ◽

Prognostic Score ◽

Scoring Systems ◽

Early Warning Score ◽

Predictive Values ◽

True Value ◽

Resource Limited ◽

Primary Health Care Centers ◽

Sensitivity Specificity

Objectives: Modified Early Warning Score (MEWS) is a reliable, safe, instant, and inexpensive score for prognosticating patients with acute pancreatitis (AP) due to its ability to reflect ongoing changes of the systemic inflammatory response syndrome associated with AP. Our study sought to determine an optimal MEWS value in predicting severity in AP and determine its accuracy in doing so. Methods: Patients diagnosed with AP and admitted to a single institution were analyzed to determine the value of MEWS in identifying severe AP (SAP). The highest MEWS (hMEWS) score for the day and the mean of all the scores of a given day (mMEWS) were determined for each day. Sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) were calculated for the optimal MEWS values obtained. Results: Two hundred patients were included in the study. The data suggested that an hMEWS value > 2 on day one is most accurate in predicting SAP, with a specificity of 90.8% and PPV of 83.3%. An mMEWS of > 1.2 on day two was the most accurate in predicting SAP, with a sensitivity of 81.2%, specificity of 76.6%, PPV of 69.8%, and NPV of 85.9%. These were found to be more accurate than previous studies. Conclusions: MEWS provides a novel, easy, instant, repeatable, and reliable prognostic score that is comparable, if not superior, to existing scoring systems. However, its true value may lie in its use in resource-limited settings such as primary health care centers.

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Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis

HPB Surgery ◽

10.1155/2013/367581 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 83

Author(s):

Ajay K. Khanna ◽

Susanta Meher ◽

Shashi Prakash ◽

Satyendra Kumar Tiwary ◽

Usha Singh ◽

...

Keyword(s):

Acute Pancreatitis ◽

Organ Failure ◽

Severe Acute Pancreatitis ◽

Pancreatic Necrosis ◽

Predictive Accuracy ◽

Promising Result ◽

Scoring Systems ◽

Apache Ii ◽

Predictive Values ◽

Using Data

Background. Multifactorial scorings, radiological scores, and biochemical markers may help in early prediction of severity, pancreatic necrosis, and mortality in patients with acute pancreatitis (AP). Methods. BISAP, APACHE-II, MOSS, and SIRS scores were calculated using data within 24 hrs of admission, whereas Ranson and Glasgow scores after 48 hrs of admission; CTSI was calculated on day 4 whereas IL-6 and CRP values at end of study. Predictive accuracy of scoring systems, sensitivity, specificity, and positive and negative predictive values of various markers in prediction of severe acute pancreatitis, organ failure, pancreatic necrosis, admission to intensive care units and mortality were calculated. Results. Of 72 patients, 31 patients had organ failure and local complication classified as severe acute pancreatitis, 17 had pancreatic necrosis, and 9 died (12.5%). Area under curves for Ranson, Glasgow, MOSS, SIRS, APACHE-II, BISAP, CTSI, IL-6, and CRP in predicting SAP were 0.85, 0.75, 0.73, 0.73, 0.88, 0.80, 0.90, and 0.91, respectively, for pancreatic necrosis 0.70, 0.64, 0.61, 0.61, 0.68, 0.61, 0.75, 0.86, and 0.90, respectively, and for mortality 0.84, 0.83, 0.77, 0.76, 0.86, 0.83, 0.57, 0.80, and 0.75, respectively. Conclusion. CRP and IL-6 have shown a promising result in early detection of severity and pancreatic necrosis whereas APACHE-II and Ranson score in predicting AP related mortality in this study.

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DIFFERENT SCORING SYSTEMS IN ACUTE ALCOHOLIC PANCREATITIS: WHICH ONE TO FOLLOW? AN ONGOING DILEMA

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201900000-53 ◽

2019 ◽

Vol 56 (3) ◽

pp. 280-285

Author(s):

Deepak JAIN ◽

Gourab BHADURI ◽

Promil JAIN

Keyword(s):

Acute Pancreatitis ◽

Organ Failure ◽

Severe Acute Pancreatitis ◽

Predictive Accuracy ◽

Scoring Systems ◽

Apache Ii ◽

Alcoholic Pancreatitis ◽

Eligibility Criteria ◽

Predictive Values ◽

Local Complications

ABSTRACT BACKGROUND: Acute pancreatitis is a common disorder in medical practice. In recent times, management has changed drastically with majority of decisions like intravenous antibiotics, negative suction with Ryle’s tube and surgical interventions like necrosectomy etc based on severity of the disease. There are different scores in use to assess severity of disease but the relative efficacy has remained a debatable subject. OBJECTIVE: The present study was thus done to investigate the predictive accuracy of different scoring systems in acute pancreatitis. METHODS: Fifty patients of acute pancreatitis admitted in medicine ward of Pt. B.D. Sharma PGIMS, Rohtak, India, were taken for study after fulfilling eligibility criteria. These patients were investigated at admission and followed up prospectively. The severity of pancreatitis was classified for each of these patients as per Revised Atlanta System of Classification. Commonly used scoring systems pertaining to acute pancreatitis, viz, BISAP, Ranson, APACHE II and modified computed tomography severity index (CTSI) were calculated. Subsequently these scores were then correlated with severity, presence of organ failure, occurrence of local complications and final outcome of the patients. RESULTS: Out of 50 patients, etiology was chronic alcohol intake in all but one with idiopathic pancreatitis. The mean age of the study population was 42.06±13.27 years. 32% of these patients had pancreatic necrosis, 40% had peripancreatic collections. 56% of them had mild acute pancreatitis, 24% had moderately severe acute pancreatitis, while 20% had severe acute pancreatitis. APACHE II had the highest accuracy in predicting severity, organ failure and fatal outcomes. As far as these parameters were concerned, the negative predictive values of BISAP score were also considerable. Modified CTSI score was accurate in predicting local complications but had limited accuracy in other predictions. CONCLUSION: APACHE II emerged as most reliable scoring system followed by BISAP and Ranson in management of the patients with acute pancreatitis. But in constraints of time and resources, even BISAP score with its significant negative predictive values served as a valuable tool for assessing and managing these patients.

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Validity of hearTest Smartphone-Based Audiometry for Hearing Screening in Workers Exposed to Noise

Journal of the American Academy of Audiology ◽

10.1055/s-0040-1718931 ◽

2020 ◽

Author(s):

Luma Cordeiro Rodrigues ◽

Silvia Ferrite ◽

Ana Paula Corona

Keyword(s):

Hearing Loss ◽

High Specificity ◽

Hearing Screening ◽

Youden Index ◽

Hearing Level ◽

Predictive Values ◽

Auditory Thresholds ◽

The Mean ◽

Low Sensitivity ◽

Sensitivity Specificity

Abstract Purpose This article investigates the validity of a smartphone-based audiometry for hearing screening to identify hearing loss in workers exposed to noise. Research Design This is a validation study comparing hearing screening with the hearTest to conventional audiometry. The study population included all workers who attended the Brazilian Social Service of Industry to undergo periodic examinations. Sensitivity, specificity, the Youden index, and positive (PPV) and negative predictive values (NPV) for hearing screening obtained by the hearTest were estimated according to three definitions of hearing loss: any threshold greater than 25 dB hearing level (HL), the mean auditory thresholds for 0.5, 1, 2, and 4 kHz greater than 25 dB HL, and the mean thresholds for 3, 4, and 6 kHz greater than 25 dB HL. Note that 95% confidence intervals were calculated for all measurements. Results A total of 232 workers participated in the study. Hearing screening with the hearTest presented good sensitivity (93.8%), specificity (83.9%), and Youden index (77.7%) values, a NPV (97.2%), and a low PPV (69.0%) for the identification of hearing loss defined as any auditory threshold greater than 25 dB HL. For the other definitions of hearing loss, we observed high specificity, PPV and NPV, as well as low sensitivity and Youden index. Conclusion The hearTest is an accurate hearing screening tool to identify hearing loss in workers exposed to noise, including those with noise-induced hearing loss, although it does not replace conventional audiometry.

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Multi-Slice Computed Tomographic Angiography for Stenosis Detection in Forearm Hemodialysis Arteriovenous Fistulas

The Journal of Vascular Access ◽

10.1177/112972980800900409 ◽

2008 ◽

Vol 9 (4) ◽

pp. 278-284 ◽

Cited By ~ 13

Author(s):

P.P.G.M. Rooijens ◽

G.P Serafino ◽

D. Vroegindeweij ◽

R. Dammers ◽

T.I. Yo ◽

...

Keyword(s):

High Specificity ◽

Computed Tomographic Angiography ◽

Observer Agreement ◽

Predictive Values ◽

Computed Tomographic ◽

Arteriovenous Fistulas ◽

Blinded Manner ◽

Sensitivity Specificity ◽

Tomographic Angiography ◽

Diameter Reduction

Purpose A method of diagnosing the extent and severity of arteriovenous fistula (AVF) stenoses is multi-slice computed tomographic angiography (MS-CTA). The aim of this prospective study was to assess the accuracy of MS-CTA for the detection and grading of stenoses in AVF in comparison to digital subtraction angiography (DSA), which was used as the gold standard of reference. Methods Fifteen hemodialysis (HD) patients with dysfunctioning forearm AVF were included. These AVFs were evaluated by both DSA and MS-CTA and were read in a prospective, blinded manner by two radiologists experienced in vascular imaging. Results ROC analysis revealed areas under the curve of 0.90 ± 0.07 for observer I and 0.87 ± 0.08 for observer II at a stenosis cut-off level of ≥50% diameter reduction. The combined results for MS-CTA showed sensitivity, specificity and positive and negative predictive values of 82%, 98%, 82% and 98% for stenoses ≥50% and 71%, 99%, 77% and 98% for stenoses ≥75%. Inter-observer agreement for the detection of stenoses ≥50% diameter reduction was 0.70 and 1.0, for MS-CTA and DSA, respectively. Conclusion MS-CTA can provide good visualization of forearm HD access AVF and has moderate sensitivity, but high specificity for the detection of flow-limiting stenoses.

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Clinical pattern of acute pancreatitis in eastern India and comparison of Ranson, BISAP and APACHE II as a predictor of severity, local complications and mortality

International Surgery Journal ◽

10.18203/2349-2902.isj20184649 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3707 ◽

Cited By ~ 1

Author(s):

Nishith M. Paul Ekka ◽

Gaurav Mishra ◽

Vinod Kumar ◽

Arun Kumar Tiwary ◽

Tanushree Kar ◽

...

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

Hospital Admissions ◽

Scoring Systems ◽

Apache Ii ◽

Aetiological Factor ◽

Serum Lipase ◽

Clinical Pattern ◽

Local Complications ◽

Complications And Mortality

Background: Acute pancreatitis is the single most frequent gastrointestinal cause of hospital admissions. Scoring systems have been used since the 1970s for assessment of its severity. This study was aimed to assess the clinical pattern of acute pancreatitis and to compare various predicting systems like Ranson, BISAP and APACHE II in predicting severity, local complications and mortality in acute pancreatitis.Methods: In this prospective study, 91 consecutive cases of acute pancreatitis admitted, between April 2015 to March 2017, were studied. The diagnostic criteria include the presence of at least two of the three features; abdominal pain, serum amylase and lipase levels and findings on imaging studies. Patients were divided into two groups each, BISAP Ranson ≥3 and <3, APACHE II ≥8 and <8, and analyzed statistically.Results: Out of total of 91 patients, 81 were male and 14 were female with mean age was 36.14 years. Commonest aetiological factor was alcoholism in 57.89% followed by gallstones in 23.16%. Serum amylase was raised in 83.26% patients while 95.79% had raised serum lipase levels. 75.79% patients were of MAP while 24.21% patients were of MSAP and SAP. 7.37% patients developed local complications and mortality rate was 6.32%. All the scoring systems were found similar in predicting severity, local complication and mortality, had low sensitivity and high specificity (P value < 0.05).Conclusions: There is no ideal predicting system for acute pancreatitis. These scoring systems can be used to triage patients for better healthcare delivery.

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Comparison of Ranson, APACHE II and APACHE III Scoring Systems in Acute Pancreatitis

Pancreas ◽

10.1097/00006676-200211000-00002 ◽

2002 ◽

Vol 25 (4) ◽

pp. 331-335 ◽

Cited By ~ 40

Author(s):

Constantinos Chatzicostas ◽

Maria Roussomoustakaki ◽

Ioannis G. Vlachonikolis ◽

Georgios Notas ◽

Ioannis Mouzas ◽

...

Keyword(s):

Acute Pancreatitis ◽

Scoring Systems ◽

Apache Ii ◽

Apache Iii

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Clinical Performance of the Spot Vision Photo Screener before and after Induction of Cycloplegia in Children

Journal of Ophthalmology ◽

10.1155/2019/5329121 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Konuralp Yakar

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Clinical Performance ◽

High Specificity ◽

Screening Criteria ◽

Predictive Values ◽

Before And After ◽

Sensitivity Specificity ◽

Vision Screener

Aim. To compare the clinical performance of the Spot Vision Screener used to detect amblyopia risk factors (ARFs) in children before and after induction of cycloplegia; the children were referred because they met the screening criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Methods. The Spot Vision Screener and a standard autorefractometer were used to examine 200 eyes of 100 children aged 3–10 years, before and after cycloplegia induction, in terms of ARFs. Sensitivity, specificity, and positive and negative predictive values for the detection of significant refractive errors were measured using the AAPOS referral criteria. It was explored that Spot Screener data were affected by cycloplegia. The extent of agreement between cycloplegic/noncycloplegic photoscreening data and cycloplegic autorefraction measurements was assessed using Wilcoxon and Spearman correlation analyses. Results. The Spot’s sensitivity was improved from 60.9% to 85.3% and specificity from 94.9% to 87.4% with cycloplegia compared to cycloplegic standard autorefractometer results. The positive predictive value of Spot was 75.7%, and the negative predictive value was 90.4% without cycloplegia. With cycloplegia, the positive predictive value of Spot was 63.6% and the negative predictive value was 95.8%. Conclusions. The Spot Screener afforded moderate sensitivity and high specificity prior to cycloplegia. The sensitivity and negative predictive value improved after induction of cycloplegia. Examiners should be aware of the effects of cycloplegia on their findings.

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Neutrophil CD64 Index as a superior biomarker for early diagnosis of infection in febrile patients in the hematology department

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2016-0118 ◽

2017 ◽

Vol 55 (1) ◽

pp. 82-90 ◽

Cited By ~ 9

Author(s):

Shu-Dao Xiong ◽

Lian-Fang Pu ◽

Hui-Ping Wang ◽

Lin-Hui Hu ◽

Yang-Yang Ding ◽

...

Keyword(s):

High Specificity ◽

Likelihood Ratios ◽

Predictive Values ◽

Combined Analysis ◽

Reactive Protein ◽

Neutrophil Cd64 ◽

Special Value ◽

Diagnostic Values ◽

Neutropenic Patients ◽

Sensitivity Specificity

Abstract Background: In the hematology department, the availability of biomarkers for early detection of infection is difficult to obtain. The present study aimed to compare the diagnostic values of neutrophil CD64 Index, procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP) and to determine whether the combined analysis of these biomarkers offer stronger predictive power in the diagnosis for the infection of febrile patients. Methods: Neutrophil CD64 Index, PCT, IL-6 and CRP levels were determined in 356 febrile patients in the hematology ward from May 2013 to May 2015. Sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, receiver operating characteristic (ROC) areas under the curve (AUC), and logistic regression analysis were determined to evaluate the diagnostic values of these biomarkers. Results: The levels of the four biomarkers were higher in the infection patients (p<0.001), and the PCT and IL-6 were higher in the patients with positive microbial blood culture (p<0.01). The neutrophil CD64 Index, PCT, IL-6, CRP had AUCs of 0.95, 0.83, 0.75 and 0.73, respectively. The best cut-off value of the neutrophil CD64 Index to detect infections was 5.06, with high specificity (87.5%) and sensitivity (88.4%). Furthermore, neutrophil CD64 Index, PCT and IL-6 offered the best combination of diagnosis with sensitivity of 93.9% and an AUC of 0.95. In addition, the neutrophil CD64 Index may have a special value to assist the physician to diagnose infection in the neutropenic patients with fever. Conclusions: The neutrophil CD64 Index is useful for early identification of infections in febrile patients in the hematology department. The combined analysis of the CD64 Index, PCT and IL-6 could further improve its sensitivity.

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Evaluation of Different Scoring Systems in Predicting the Severity of Acute Pancreatitis

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/537 ◽

2020 ◽

Vol 7 (45) ◽

pp. 2604-2610

Author(s):

Rohan J. Harsoda ◽

Sharma Vipin Jaishree ◽

Krishna Prasad G.V

Keyword(s):

Acute Pancreatitis ◽

Scoring System ◽

Scoring Systems ◽

Apache Ii ◽

Prediction Of Outcome ◽

Poor Outcome ◽

Increased Risk ◽

Highly Sensitive ◽

Poor Outcomes ◽

Ranson Score

BACKGROUND Accurate prediction of the severity of acute pancreatitis will help in identifying patients at increased risk for morbidity and mortality. We wanted to evaluate the different scoring systems in predicting the severity of acute pancreatitis. METHODS This cross-sectional study was undertaken in the Department of Surgery at a zonal hospital between April 2013 and December 2014. RESULTS 40 patients were selected and enrolled in the study as per the selection criteria. 20 (50 %) patients had fair outcome and 20 (50 %) had a poor outcome. Accuracy of different scoring systems in predicting patient outcome ranged from 45 % (48-hr APACHE II) to 62.5 % (Goris MOF at baseline and 48 hr). Baseline Goris MOF was 70 % sensitive and 55 % specific in prediction of poor outcome. It had an accuracy of 62.5 % in prediction of outcome. 48-hr Goris MOF was 80 % sensitive and 45 % specific in predicting the outcome. Baseline APACHE II scores were below the cut-off level in all the patients. 48-hr APACHE II scores were 5 % sensitive and 100% specific for prediction of outcome. Ranson score > 3 was 25 % sensitive and 90 % specific in the prediction of outcome. Balthazar score > 6 was 65 % sensitive and 55 % specific in prediction of outcome. Ranson score was found to have a limited sensitivity for different outcomes (ranging from 21.1 % to 50 %) but was found to have a high specificity (83.8 % to 90 %). CONCLUSIONS Goris scoring system (at 48 hrs) was found to be highly sensitive to different poor outcomes as well as duration of hospital stay. It also correlated with Balthazar scoring system, which was also highly sensitive to different poor outcomes studied. KEYWORDS Acute Pancreatitis, Prediction, Scoring System, APACHE II, Goris MOF, Ranson’s Score, Balthazar Score

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