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Comparison of Apache II And CT Scoring System In Predicting Early Outcome of Acute Pancreatitis
Dr. Umakant Chate, Dr. Rameshkumar Pandey, Dr. Prutha Javalekar, Dr. Dilip Gupta
DOI : 10.5281/zenodo.8276285
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Abstract

Acute pancreatitis (AP) is a common and frequent inflammatory disorder of the pancreas with variable involvement of other regional tissues or remote organ systems. Early diagnosis and precise staging of disease severity are important goals in the initial evaluation and management of AP.APACHE II is the most accurate predictor of mortality, CTSI is a good predictor of bothmortality and AP severity, therefore, we compared APACHE II and CT scoring system in predicting early outcome of AP.Patient’s demographic and clinical data/Laboratory /Radiological diagnosis of Acute pancreatitis were analysed. The patients were graded according to Balthazar grading and modified CT severity index. The patients were given a score according APACHE II scoring system. Based on APACHE II scoring and CT grading, the severity, complications and prognosis of the patients was assessed. Data was analyzed and found that, alcohol is the major cause of acute pancreatitis in the regional population, with gallstones being the second most common cause. Overall, APACHE II score is an effective tool for risk stratification and management of patients with AP. As APACHE II is a clinical study and calculated at the time of admission, clinically it can be valued higher than the CTSI which is usually done after 48 hours. APACHE II score of >8 or =8 in predicting severity of acute pancreatitis had sensitivity of 93.75% and negative predictive value of 97.6%. Mild pancreatitis as evidenced by CT score < 4 and APACHE II score < 8 have better prognosis. Oral diet is tolerated faster, sepsis is minimal and local complications are lesser. Severe pancreatitis as evidenced by CT scores > 4 and APACHE II score of ≥ 8 have severe metabolic and electrolyte disturbances. Prognosis is guarded, especially those who have acute respiratory distress syndrome and features of multi organ dysfunction syndrome. In conclusion, this study suggests that the use of APACHE II score is very useful in predicting the severity of acute pancreatitis in patients. This can help in determining the appropriate level of care and management for the patients, ultimately improving their outcomes and reducing the burden on healthcare facilities.

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