Objective To compare the predictive value of BISAP (bedside index for severity in acute pancreatitis),APACHE Ⅱ (acute physiology and chronic health evaluation Ⅱ),and Ranson scoring system in persistent organ failure (POF) and mortality in patients diagnosed as acute pancreatitis (AP) based on the revised Atlanta classification.Methods Demographic,clinical and laboratory data of 350 consecutive AP patients admitted to the First Affiliated Hospital of Nanchang University were prospectively collected from November,2009 to January,2012.A retrospective analysis was performed and 310 patients finished the follow-up.The median age of whole population was (50.5 ± 16.4) years old.Patients were classified into early phase group (≤7 days) and late phase group (＞7 days) based on the interval between onset of AP and admission.Demographics and clinical data were collected to calculate Ranson,APACHE Ⅱ and BISAP scores during the first 3 days of hospitalization.Poor prognosis was defined as POF or death.Results The three scoring systems similarly demonstrated modest accuracy for predicting POF or death in early phase group[area under the receiver operating characteristic curve (AUCROC):0.68-0.84],but failed to predict the prognosis of AP patients in late phase group.Daily scoring of APACHE Ⅱ and BISAP on the first 3 days after admission demonstrated modest to high predictive accuracy to poor prognosis (AUCROC:0.69-0.95),but this was not statistically significant (P ＞ 0.05).Conclusions These three clinical scoring systems show modest accuracy for predicting POF or death in AP patients on the early phase based on the revised Atlanta classification.The BISAP scoring system has similar prognostic value to APACHE Ⅱ and Ranson.However,due to the simplicity and convenience,BISAP scoring system is more popular in clinical practice.Daily scoring on the first 3 days after admission fails to predict the prognosis accurately.%目的 采用基于新亚特兰大分类的急性胰腺炎(AP)定义,比较急性胰腺炎严重程度床边指数(BISAP)、急性生理与慢性健康评分Ⅱ(APACHEⅡ)和Ranson评分对AP患者死亡和持续性器官功能不全的预测价值.方法 回顾性分析前瞻性收集的2009年11月-2012年1月在南昌大学第一附属医院住院的连续AP患者资料350例,其中完成随访的310例纳入本研究,年龄(50.5±16.4)岁.将其分为起病至就诊时间≤7 d组(发病早期)和＞7d组(发病后期).计算患者入院后前3d各评分系统的分值.治疗并随访患者至腹痛消失、血淀粉酶正常.比较3种评分系统预测患者持续性器官功能不全及死亡的接受者操作特征曲线下面积(AUCROC),并计算3种评分预测的最佳阈值、灵敏度、特异度和约登指数.结果 (1)入院第1天BISAP评分、APACHEⅡ评分和入院48 h的Ranson评分预测持续性器官功能不全及死亡的价值中等(AUCRoC0.68 ～0.84),3者比较差异无统计学意义(P值均＞0.05).但3种评分系统对就诊时间＞7d组患者预后的预测均无统计学意义(P值均＞0.05).(2)入院后前3d中,每天的BISAP和APACHEⅡ评分对AP患者预后都有中或高度的预测价值,但各天的预测价值的差异无统计学意义(P值均＞0.05).结论 此3种临床评分系统对新亚特兰大分类下的AP预后预测价值中等,且只适合在发病早期使用.新提出的BISAP评分虽不优于传统的Ranson评分和APACHEⅡ评分,但其使用简便,值得推广.入院后连续3d的动态评分并不能提高APACHEⅡ和BISAP评分对AP预后的预测价值.
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