How to score acute pancreatitis in the emergency setting: ﬁve systems against ED-SAS
1Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, 34147 İstanbul, Turkey
2Department of Emergency Medicine, University of Health Sciences, Kartal Dr. Lütﬁ Kırdar City Hospital, 34363 İstanbul, Turkey
DOI: 10.22514/sv.2021.147 Vol.17,Issue 5,September 2021 pp.122-129
Submitted: 07 July 2021 Accepted: 13 August 2021
Published: 08 September 2021
To assess the effectiveness of a new scale known as “Emergency department SpO2 (peripheral capillary oxygen saturation), age, and SIRS (Systemic inflammatory response syndrome)” (ED-SAS) that can be used to predict prognosis within 24 hours following presentation compatible with acute pancreatitis in patients admitted to the emergency department. This research project was conducted as a single-center, retrospective, cohort study. The Acute Physiology and Chronic Health Evaluation II (APACHE II), SIRS, Bedside Index for Severity in Acute Pancreatitis (BISAP), ED-SAS, modified Glasgow Scale and Ranson criteria scoring of the patients were evaluated using their presentation data screened from the hospital automation system. Then, the efficiencies of these evaluation systems were compared using the receiving operating curve (ROC). The conformity of the data to the normal distribution was checked with the Kolmogorov-Smirnov test. The ROC analyses were employed to identify the cut-off values of the scoring systems in calculating death rates. The method developed by DeLong et al. was used to compare the ROC curves of the scoring systems. The study has been completed with 235 patients, 91 (38.7%) male and 144 (61.3%) female, with a mean age of 63.1 ± 17.7 years. In the ROC analysis of the ED-SAS evaluation tool to predict death rates, the area under the curve (AUC) value was found to be 0.85 (95% confidence interval: 0.79–0.89), and the Youden index was 0.62, with a p value of 0.001. Mortality prediction with ED-SAS significantly differed compared to the Ranson and SIRS scoring systems (P = 0.001 and P = 0.03, respectively). However, no statistically significant difference was found in the comparison of the ED-SAS score with the modified Glasgow and APACHE II scores (P = 0.12 and P = 0.54, respectively). It was concluded that the Baseband ED-SAS scores provided equally significant results in terms of AUC at the 95% confidence interval (P = 0.05). Statistical analyses revealed that the APACHE II, SIRS, BISAP, modified Glasgow and ED-SAS scores were found to be significantly higher among the dead in comparison to the survivors (P < 0.05). ED-SAS constitutes a simple, fast, expedient and effective evaluation system that can be utilized to predict mortality in acute pancreatitis in the emergency setting.
Acute pancreatitis; Predictive scores; Emergency department
Mehmet Özgür Erdogan,Nihat Mujdat Hokenek. How to score acute pancreatitis in the emergency setting: ﬁve systems against ED-SAS. Signa Vitae. 2021. 17(5);122-129.
 van den Berg FF, de Bruijn AC, van Santvoort HC, Issa Y, Boermeester MA. Early laboratory biomarkers for severity in acute pancreatitis; a systematic review and meta-analysis. Pancreatology. 2020; 20: 1302–1311.
 Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of Gastrointestinal Disease in the United States: 2012 Update. Gastroenterology. 2012; 143: 1179–1187.e3.
 Cho JH, Kim TN, Chung HH, Kim KH. Comparison of scoring systems in predicting the severity of acute pancreatitis. World Journal of Gastroenterology. 2015; 21: 2387–2394.
 Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World Journal of Emergency Surgery. 2019; 14: 27.
 Bradley EL. A clinically based classification system for acute pancre-atitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Archives of Surgery. 1993; 128: 586–590.
 Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut. 2004; 53: 1340–1344.
 Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroen-terology guideline: management of acute pancreatitis. The American Journal of Gastroenterology. 2013; 108: 1400–15; 1416.
 Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62: 102–111.
 Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson’s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. The American Journal of Gastroenterology. 2010; 105: 435–41; quiz 442.
 Silva-Vaz P, Abrantes AM, Castelo-Branco M, Gouveia A, Botelho MF, Tralhão JG. Murine Models of Acute Pancreatitis: a Critical Appraisal of Clinical Relevance. International Journal of Molecular Sciences. 2019; 20: 2794.
 Párniczky A, Kui B, Szentesi A, Balázs A, Szűcs Á, Mosztbacher D, et al. Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis. PLoS ONE. 2016; 11: e0165309.
 Mounzer R, Langmead CJ, Wu BU, Evans AC, Bishehsari F, Muddana V, et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology. 2012; 142: 1476–1476.
 Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Localio SA. Objective early identification of severe acute pancreatitis. The American Journal of Gastroenterology. 1974; 61: 443–451.
 Larvin M, Mcmahon M. APACHE-II Score for assessment and monitor-ing of acute pancreatitis. The Lancet. 1989; 334: 201–205.
 Doğanay F, Elkonca F, Seyhan AU, Yılmaz E, Batırel A, Ak R. Shock index as a predictor of mortality among the Covid-19 patients. The American Journal of Emergency Medicine. 2021; 40: 106–109.
 Ak R, Kurt E, Bahadirli S. Comparison of 2 Risk Prediction Models Specific for COVID-19: The Brescia-COVID Respiratory Severity Scale Versus the Quick COVID-19 Severity Index. Disaster Medicine and Public Health Preparedness. 2021. (in press)
 Neoptolemos JP, Kemppainen EA, Mayer JM, Fitzpatrick JM, Raraty MG, Slavin J, et al. Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. Lancet. 2000; 355: 1955–1960.
 Steinberg WM. Predictors of severity of acute pancreatitis. Gastroenterol-ogy Clinics of North America. 1990; 19: 849–861.
 Blamey SL, Imrie CW, O’Neill J, Gilmour WH, Carter DC. Prognostic factors in acute pancreatitis. Gut. 1984; 25: 1340–1346.
 Besselink M, van Santvoort H, Freeman M, Gardner T, Mayerle J, Vege SS, et al. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013; 13: e1–15.
 Zhang X, Deng L, Chen W, Shi N, Jin T, Lin Z, et al. Circulating microRNA 216 as a Marker for the Early Identification of Severe Acute Pancreatitis. The American Journal of the Medical Sciences. 2017; 353: 178–186.
 Miller J, Wu Y, Safa R, Marusca G, Bhatti S, Ahluwalia G, et al. Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study. BMC Emergency Medicine. 2021; 21: 16.
 Ahluwalia G, Wu Y, Gomez H, Farook N, Scott A, Nair V, et al. 475: Emergency department spo2, age, and sirs (ed-sas) score predicts mortality in acute pancreatitis. Critical Care Medicine. 2020; 48: 218–218.
 Dandashi J, Wu Y, Farook N, Safa R, Ahluwalia G, Marusca G, et al. Derivation and validation of the ED-SAS score for early prediction of mortality in acute pancreatitis. Academic Emergency Medicine 2020; 27: S51.
 Papachristou GI, Papachristou DJ, Avula H, Slivka A, Whitcomb DC. Obesity Increases the Severity of Acute Pancreatitis: Performance of APACHE-O Score and Correlation with the Inflammatory Response. Pancreatology. 2006; 6: 279–285.
 DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44: 837–845.
 Waller A, Long B, Koyfman A, Gottlieb M. Acute Pancreatitis: Updates for Emergency Clinicians. The Journal of Emergency Medicine. 2018; 55: 769–779.
 De Bernardinis M, Violi V, Roncoroni L, Boselli AS, Giunta A, Peracchia A. Discriminant power and information content of Ranson’s prognostic signs in acute pancreatitis: a meta-analytic study. Critical Care Medicine. 1999; 27: 2272–2283.
 Abu-Zidan FM, Bonham MJ, Windsor JA. Severity of acute pancreatitis: a multivariate analysis of oxidative stress markers and modified Glasgow criteria. the British Journal of Surgery. 2000; 87: 1019–1023.
 Singh VK, Wu BU, Bollen TL, Repas K, Maurer R, Johannes RS, et al. A Prospective Evaluation of the Bedside Index for Severity in Acute Pancreatitis Score in Assessing Mortality and Intermediate Markers of Severity in Acute Pancreatitis. The American Journal of Gastroenterology. 2009; 104: 966–971.
 Singh VK, Wu BU, Bollen TL, Repas K, Maurer R, Mortele KJ, et al. Early Systemic Inflammatory Response Syndrome is Associated with Severe Acute Pancreatitis. Clinical Gastroenterology and Hepatology. 2009; 7: 1247–1251.
 Silva-Vaz P, Abrantes AM, Castelo-Branco M, Gouveia A, Botelho MF, Tralhão JG. Multifactorial scores and biomarkers of prognosis of acute pancreatitis: Applications to research and practice. International Journal of Molecular Sciences. 2020; 21: 338.
 Shields CJ, Winter DC, Redmond HP. Lung injury in acute pancreatitis: mechanisms, prevention, and therapy. Current Opinion in Critical Care. 2002; 8: 158–163.
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