Early prediction of acute pancreatitis: prospective study comparing computed tomography scans, Ranson, Glascow, Acute Physiology and Chronic Health Evaluation II scores, and various serum markers

Article Article scientifique Article Early prediction of acute pancreatitis: prospective study comparing computed tomography scans, Ranson, Glascow, Acute Physiology and Chronic Health Evaluation II scores, and various serum markers eng 2002 author Robert John 55421 author Frossard Jean-Louis 35038 author Mermillod Bernadette 22748 author Soravia Claudio 126700 author Mensi Nouri author Roth Marc 25028 author Rohner Adrien 25026 author Hadengue Antoine 30244 author Morel Philippe 22337 612-619 10.1007/s00268-001-0278-y 12098056 0364-2313 The aim of this study was to assess the predictability of the outcome of acute pancreatitis using the Ranson, Glascow, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, the computed tomography (CT) scan, and several serum markers. Altogether, 137 consecutive patients with acute pancreatitis confirmed by CT scan were prospectively included. Blood samples were obtained daily for 6 days. The predictive value of each parameter was studied by univariate and multivariate analyses comparing mild and severe pancreatitis. A total of 111 attacks were graded as mild (81%) and 26 as severe (19%). Ranson (p = 0.3) and APACHE II (p = 0.049) scores appeared insufficiently predictive in the univariate analysis. Pancreatic imaging by CT scan was insufficiently predictive (p > 0.05), whereas the presence of extrapancreatic fluid collections was more indicative of outcome (p <0.05). With the univariate analysis, the four most reliable serum markers were pancreatic amylase (p <0.001), neutrophil elastase (p <0.05), albumin (p <0.002), and C-reactive protein (p <0.001). Results became homogeneous when the CT results were added; serum albumin plus extrapancreatic fluid collections (negative predictive value 92%-96% and positive predictive value 67%-100%) comprised the best indicator of severity. None of the parameters tested achieved sufficient predictability when used alone. Serum albumin plus extrapancreatic fluid collections comprise the best indicator of severity at the time of admission. APACHE Acute Disease Adult Aged Aged, 80 and over Amylases/blood Female Humans Male Middle Aged Pancreatitis/diagnosis Predictive Value of Tests Prospective Studies Sensitivity and Specificity Severity of Illness Index Time Factors Tomography, X-Ray Computed Dewey 616 Dewey 617 56 Département de médecine 221 57 Département de chirurgie 222 false 79 Chirurgie viscérale 104 1329 Chirurgie viscérale (HUG) 335 Pancréatite aiguë 601 World journal of surgery 26 5 232b4611-82ae-4978-98a8-20012c8bc457 Article (Published version) Restricted art%253A10.1007%252Fs00268-001-0278-y.pdf 906837 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de chirurgie

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Early prediction of acute pancreatitis: prospective study comparing computed tomography scans, Ranson, Glascow, Acute Physiology and Chronic Health Evaluation II scores, and various serum markers	World journal of surgery			2002	807	0

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