Table 1 Clinical scoring system for the early prediction of acute pancreatitis severity
From: Acute pancreatitis: mechanisms and therapeutic approaches
Scoring system | Scoring content | Advantage | Disadvantage | Application | Ref. |
|---|---|---|---|---|---|
1974-Ranson | Eleven indexes (five assessed at admission and six within 48 h), such as age, WBC, LDH, blood sugar, BUN, HCT, etc. | 1. Have the longest history and is widely used in clinic; 2. Multiple clinical and laboratory parameters make it possible to consider patients more comprehensively, thus improving the reliability of prediction; 3. The parameters of 48 h after admission can reflect the dynamic changes of patients’ condition | 1. Need to be evaluated twice (at admission and 48 h after admission), and the operation is complicated; 2. Do not evaluate organ failure | Early prediction of SAP and mortality | |
1978- Glasgow Imrie | Eight indicators (evaluated within 48 h), such as PaO₂, albumin, serum calcium, etc. | The high specificity for evaluating the incidence of serious diseases | Early prediction ability is limited | Predict severe AP | |
1985-APACHE II | 12 physiological indexes, age and history of chronic diseases | 1. The sensitivity of predicting the severity of AP is the highest; 2. Predicting the prognosis of SAP has the strongest predictive ability | Complex (multiple indicators need to be calculated) | Predict the severity of AP and the prognosis of SAP | |
1990- CTSI | Based on CT classification (A-E) and necrosis range | Evaluating AP patients shows superior performance in terms of mortality, persistent organ failure, and local complications, and can intuitively assess pancreatic necrosis and complications | Early ( < 48 h) assessment may underestimate necrosis | Imaging evaluation of necrosis, infection risk, and surgical indications | |
1992- SIRS | 1. Body temperature > 38 °C or <36 °C; 2. Heart rate >90 beats/min; 3. Respiratory frequency > 20 beats/min or PaCO2 < 32 mmHg (1 mmHg=0.133 kPa); 4. The total number of WBC is more than 12×109/L or less than 4×109/L, or the proportion of immature neutrophils is more than 10%. Those with two or more of the above conditions are diagnosed as SIRS | High sensitivity in predicting early organ failure and mortality | Require dynamic monitoring | Lack specificity for SAP, making it more suitable as a screening rather than a diagnostic tool | |
1994- SOFA | Six organ function indexes (respiration, coagulation, liver, circulation, CNS, kidney) | In patients with septic shock, the predictive ability of the SOFA score is better than that of other scores | Require dynamic monitoring | Severity Assessment of SAP Complicated with MODS | |
2007-POP | Six indicators: age (years), mean arterial pressure (mmHg), PaO₂/FiO₂, pH value, urea (mg/dl) and calcium (mg/dl) | 1. Cheap, simple, rapid and high specificity; 2. Stratified patients with biliary AP, and timely guided medical management according to the severity | Less research, not widely verified | As a prognostic indicator | |
2008- BISAP | Five simple indicators (SIRS, altered mental status, age, BUN and pleural effusion) | Simple and quick, high specificity in predicting adverse outcomes such as organ failure, persistent organ failure, and pancreatic necrosis | 1. Lower sensitivity; 2. The collection of imaging data is prone to omissions | Early screening of SAP and mortality risk | |
2009- HAPS | Three indicators: the patient’s physical examination results, as well as routine laboratory measurements of hematocrit and serum creatinine | Minimalism (assessment upon admission) | Only MAP is identified, and SAP is not predicted | Rapid and preliminary identification of patients with AP without intensive care | |
2017- PASS | Includes objective items (organ failure and SIRS) and subjective items (abdominal pain, morphine uses and the ability to tolerate solid diet) | The best predictor of mortality and organ failure, especially ARDS | Clinical data on its utility are still limited | Predict mortality and organ failure | |
2020- CSSS | Six variables: including serum creatinine, blood sugar, lactate dehydrogenase, heart rate, CRP and degree of pancreatic necrosis | The prediction accuracy of pancreatic infection is the highest | No research to evaluate CSSS, and research with larger sample size and prospective design is needed to verify it | Predict SAP severity and infection |
