COMPARATIVE STUDY OF RANSON'S VERSUS APACHE II SCORING SYSTEMS IN PREDICTING THE CLINICAL OUTCOME IN PATIENTS WITH ACUTE PANCREATITIS

Dr. Alex arthur Edwards; Dr. B.M.Pabithadevi

Volume : IX, Issue : III, March - 2019

COMPARATIVE STUDY OF RANSON'S VERSUS APACHE II SCORING SYSTEMS IN PREDICTING THE CLINICAL OUTCOME IN PATIENTS WITH ACUTE PANCREATITIS

Dr. Alex Arthur Edwards, Dr. B. M. Pabithadevi

Abstract :

INTRODUCTION: Acute pancreatitis is an acute inflammatory process of the pancreas with varying involvement of other regional tissues or remote organ systems. About 80% of the attacks are mild, 20% are severe and they are commonly accompanied by necrosis of the pancreas and or organ failure. Pathologically there are two types of pancreatitis, interstitial and necrotizing. Patho physiologic mechanisms include micro–circulatory injury, leucocyte chemo–attraction, release of pro and anti–inflammatory cytokines, oxidative stress, leakage of pancreatic fluid into the region of pancreas, bacterial translocation to the pancreas and systemic circulation. The initial step in the pathogenesis of acute pancreatitis is conversion of trypsinogen to trypsin within acinar cells in sufficient quantities to overwhelm normal mechanisms to remove active trypsin. Materials and Methods Present study was aimed at analyzing patients admitted to Department of General Surgery, in a tertiary care centre with a diagnosis of acute pancreatitis during the period between December 2015 and May 2017. All the patients were subjected to detailed clinical examination, laboratory investigations and radiological imaging. All the100patients were subjected to both Ranson’s and APACHEII scoring systems. Scoring was done on admission/time of diagnosis and at 48 hours. The scores were compared with the clinical severity which was graded according to Atlanta criteria and also compared with the clinical outcome. Results and Discussion: Ranson’s Score and APACHE II Score in severe acute pancreatitis were significantly higher than those in the mild cases (p<0.001). The Ranson’s scores were very sensitive for prediction of systemic complications (100%) but less sensitive for prediction of local complications (93.33). As Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy are found to be the same for Ranson’s and APACHEII scores, Ranson’s scoring system is equally efficacious as APACHEII scoring system in assessing the prognosis of acute pancreatitis. CONCLUSION: From this study, we can conclude Ranson’s scoring system is not inferior to APACHEII scoring system in predicting the severity of acute pancreatitis. Ranson’s scoring system is a simple, cheap, easy to remember, recollect, and calculate scoring system. Moreover, Ranson’s scoring system was developed specifically for acute pancreatitis. In the developing world, where cost effectiveness of each test is important, Ranson’s scoring system can be used in place of APACHE II scoring system. The Ranson’s scoring system accurately predicts the outcome in patients with acute pancreatitis and compares favourably with the physiological scoring systems in the prediction of disease severity for acute pancreatitis, the only disadvantage being a 24hours delay.