Acute Pancreatitis (AP) is common and one of the most potentially dangerous disorder with a highly variable clinical course. The clinical course of Acute Pancreatitis (AP) varies greatly between patients from a mild pancreatic inflammation treated conservatively to a severe disease resulting in multiple organ failure, infected pancreatic necrosis and mortality. Severity of Acute Pancreatitis is linked to presence of Systemic Organ Dysfunctions and/or pancreatitic necrosis.
Acute Pancreatitis can be classified as mild and severe form. Mild acute pancreatitis is characterized by interstitial edema of the gland in whom short term remission is achieved. Whereas in the severe form, there is presence of pancreatic necrosis, severe systemic inflammatory response and multiorgan failure which can lead to death.
Hence it is of utmost importance to identify the patients at risk for organ failure early in the disease course during admission that will assist in triage, appropriate level of care and initiation of aggressive early treatment that will likely decrease mortality.
Many severity scoring systems have been developed for early detection of SAP (Severe Acute Pancreatitis) over the years. The Ranson Score represented a major advancement in evaluation of disease severity of AP in early years. Since then, many other scoring systems have been made for assessing the same as follows: Acute Physiology and Chronic Health Evaluation 2 (APACHE-2) Modified Glasgow Score (MGS) CT Severity Index (CTSI) Pancreatis Outcome Prediction (POP) Harmless Acute Pancreatis Score (HAPS) Bedside Index for Severity in Acute Pancreatitis (BISAP) MOSS score SIRS Score Japanese Severity Score (JSS) The two most popular criteria used to be Ranson and Glasgow scoring system. Ranson criteria has been used for a long time; as it requires a complete assessment after 48 hours for the score to be calculated, so results are available late. The (APACHE II) is widely used in predicting the severity of acute pancreatitis. The major advantage of the APACHE II scoring system, as compared with the other systems, is that it can be used in monitoring the patient’s response to therapy while Ranson and Glasgow scales are mainly meant for assessment at the presentation. It requires the collection of a large number of parameters which makes it Complex and cumbersome. BISAP and HAPS score are recently developed scores which takes into account comparatively fewer parameters and can be performed bedside within initial few hrs. These scoring systems incorporate physiologic, laboratory, and occasionally radiographic parameters by using cut off values. Recently, attention has also been focused on the role of individual laboratory parameters in assessing severity such as blood urea nitrogen (BUN), Creatinine, Procalcitonin etc. Recently, in 2008 an overall revision was made to the severity assessment in Japanese guidelines and a New Japanese Severity Score (JSS) was developed for the assessment of severity of Acute Pancreatitis. In the new severity assessment criteria (JSS), the diagnosis of severe acute pancreatitis can be made according to nine prognostic factors and/or the computed tomography (CT) grade, determined on the basis of contrast-enhanced CT. It also recommends that severity assessment is made first on the basis of prognostic factors that can be assessed at any time and everywhere, and that contrast-enhanced is performed in cases in which pancreatic necrosis is suspected by plain-CT. It is also recommended that in cases where worsening of disease is suspected, CECT is performed even if prognostic factor score is less than 2 points. This study intends to study the accuracy of Prognostic factor of JSS and APACHE-2 to assess the severity of Severe Acute Pancreatitis (SAP) in the Emergency Department (ED). AIM AND OBJECTIVES OF THE STUDY: 1.To evaluate the ability of Prognostic factor in Japanese Severity Score (JSS) to predict severity in acute pancreatitis patients from our hospital 2.To evaluate the ability of the APACHE-2 score to predict which patients are at risk for development of organ failure, and pancreatic necrosis. 3.To compare efficacy of Prognostic Factor in JSS score and APACHE-2 Score in predicting severity of Acute Pancreatitis.
I want to do this study to compare the JSS Score - Prognostic factor and APACHE-2 in predicting the Severity of Acute pancreatitis to find out which is more efficacious at the time of admission. As this study has not been done in this part of India, I want to go forward with this study.
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