Researchers from Germany, Italy, and the USA, assessed the use of the APACHE II score in diagnosing necrotizing pancreatitis.
The APACHE II score is highly recommended worldwide for the assessment of severe pancreatitis (interstitial and necrotizing). A score of at least 8 points on admission to the hospital is said to indicate severe pancreatitis.
A total of 326 patients with a first attack of acute pancreatitis were included in the prospective study.
All patients underwent contrast-enhanced computed tomography (CT) within 72 hours of admission.
A number of parameters were used to assess the severity of the disease.
These included respiratory and renal failure, according to the Atlanta classification; indication for dialysis, ventilation, and surgery; and time spent in intensive care unit and total hospital stay.
Ranson score adjusted for cause; Imrie score; and Balthazar score (CT) were also used.
|APACHE II score for diagnosing necrotizing pancreatitis:|
| Pancreas |
Of the 326 patients, 80% had interstitial pancreatitis and 20% had necrotizing pancreatitis.
In 28% of the patients with interstitial pancreatitis, the APACHE II score was at least 8 points, indicating severe pancreatitis (overestimation of the disease).
The score was less than 8 in 64% of the patients with necrotizing pancreatitis (underestimation).
The team found that sensitivity and specificity of the APACHE II score were 36% and 72%, respectively.
The positive predictive value was 24% and the negative predictive value was 82%.
Paul Georg Lankisch, of the Municipal Clinic of Lüneburg, Lüneburg, Germany, said on behalf of his group, "The evaluation of sensitivity, specificity, and positive and negative predictive value for all APACHE II score points showed that there was not a "golden" cutoff to detect necrotizing pancreatitis."
"The APACHE II score on admission to the hospital is unreliable to diagnose necrotizing pancreatitis," he concluded.