The importance of using inflammatory biomarkers and scoring systems in early assessment of severity and outcome of acute pancreatitis treatment

Abstract

Acute pancreatitis (AP) is an inflammatory disease of the pancreas that causes local damage and systemic inflammatory response. Some of the numerical scoring systems used in the intensive care unit for the assessment of critically ill patients such as APACHE II and MEWS score could be used for AP, beside the scoring systems specific to AP (Ranson score, Pancreas score, BISAP). Therefore, the aim of this study was to examine the significance of inflammatory biomarkers and scoring systems in the evaluation of the severity of AP and outcomes. The study was conducted as a cohort prospective study, examining patients with AP, of both sexes. Laboratory analyses, as well as the scoring systems: Ranson, Pancreas score, Bedside Index of Severity in Acute Pancreatitis (BISAP), and Acute Physiology and Chronic Health Evaluation II (APACHE II) were collected on day zero and 48h after admission. The study included 50 patients of whom 8 died. The most reliable score for predicting AP severity was APACHE II0 and 48AUROC (0.753; 0.768) in relation to the inflammatory biomarkers. For initial prediction of the treatment outcome, APACHE II0, BISAP0, and CRP0 AUROC (0.813; 0.807; 0.753) had the highest discrimination rates and after 48h, APACHE II48, Ranson48, BISAP48, and Pancreas48 AUROC (0.917; 0.856; 0.789; 0.729). There was a statistically significant correlation between CRP0 and BISAP0 (p=0.006) and between PCT and all day-zero scores. All tested screening systems showed reliability in predicting AP severity and treatment outcomes. The best predictive power was demonstrated by the APACHE II score.