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2005, Number 2

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Cir Gen 2005; 27 (2)

Evaluation of scales and prognostic factors in severe acute pancreatitis.

Rosas FMA, Gaxiola WR, Ibáñez GO, Vargas TE, Meza VMA, Calvo IJB

Language: Spanish
References: 35
Page: 137-143
PDF size: 60.37 Kb.


ABSTRACT

Objective:The purpose of this work was to evaluate scores and severity prognostic biochemical tests in cases of acute pancreatitis in Hospital General de Mexico O.D.
Introduction:Most patients with ongoing acute pancreatitis suffer a mild form of the disease; nevertheless, between 15 to 25% of the patients experience a clinical picture of severe acute pancreatitis. Frequently, and due to different logistic problems, most of the serology markers and roentgenographic studies are not available in Mexico. With these studies, early outcome and severity of the disease can be predicted and evaluated. Thus, emergency and surgical departments throughout the country use various accessible, economic and easy to perform scores, with good reported sensitivity and specificity.
Methods:Records of patients presenting with diagnosis of acute pancreatitis from January 1998 to December 2003 were reviewed. Parameters included in the following scores were evaluated: Balthazar tomographic criteria, Glasgow coma score, Ranson criteria, Osborne score, APACHE II, hematocrit, serum calcium, base deficit. Severity of the disease was based on criteria established by the Consensus of Atlanta. Methods of descriptive statistics with probabilistic tables and graphs of frequency were employed. Thus, obtaining sensitivity, specificity, and positive and negative predictive values of scores and prognostic factors used to determine the severity of acute pancreatitis.
Results:Total cases of acute pancreatitis were 207, forty-seven of which had severe pancreatitis and 160 patients had mild pancreatitis. Overall best resultsfor sensitivity were obtained with tomographic criteria of Balthazar (97%), while results for specificity were highest for serum calcium and Ranson criteria, 95% and 94%, respectively. In the case of predictive values, the APACHE II scoring system got the best results for positive predictive value (81%), and the tomographic criteria of Balthazar obtained 99% of negative predictive value.
Conclusion:In the clinical practice, our patients should continue to be evaluated with those prognostic scores that got the best results, until either one chemical, clinical or radiologic factor is found to provide a better assessment of severity in these type of patients, which is further reproducible, and accessible to all medical units throughout the country.


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