Simple Scoring System for the

Prediction of the Prognosis of Severe

Acute Pancreatitis (SAP)

Journal of Surgery
Official Publication:
SOCIETY OF UNIVERSITY SURGEONS
CENTRAL SURGICAL ASSOCIATION
AMERICAN ASSOCIATION OF ENDOCRINE
SURGEONS

January 2007 Volume 141 (Page 51-58)

From the Department of Gastroenterological Surgery, Kobe University Graduate School of Medical Sciences, Kobe,
and the Department of Surgery, Kinki University School of Medicine, Osaka-sayama, Japan

By: Amir Reza Honarmand

 Background

 High mortality of SAP

The importance of prediction of the prognosis
in the initial period
Complication of most scoring systems for
severity of acute pancreatitis(multiple factors)
(Ranson 11 factors; Glasgow 8 factors; APACHE II 14 factors; and
JSS 18 factors)
 Patients and Methods
 137 patients with SAP(101 male,36 Female ,
Age :53.9)
 40 deathes (9 patients within 10 days, 31 died of late
complications)
 Blood biochemical data were obtained and Ranson,
Glascow, APACHE II and Jss scores were estimated
at the time of admission.
 Dynamic contrast-enhanced CT was also performed
 Patients and Methods
 All 137 patients were divided into survivor
group(97 patients) and non survivor group(40
patients)
 The data was analyzed by receiver operator
characteristic(ROC) curves.
 The area under the curve (AUC) was evaluated
and the optimum cutoff level was determined for
each factor.
 Multivariate analysis was carried out to
determine indipendent variables the were
associated with death.
 Results

Optimum cutoff level for BUN : 25 mg/dL

Optimum cutoff level for LDH : 900 IU/L
 Results

 Independent predictable factors for prognosis were

LDH level and Blood sugar level.
 Prognostic factor in imaging study was the presence
of pancreatic necrosis in CE-CT findings.
 The degree of pancreatic necrosis was not essential.
Results
 SPS

 Simple scoring system for the prediction of the

prognosis of SAP(SPS) :
• BUN level ≥25 mg/dL
• LDH level ≥900 IU/L
• Pancreatic necrosis in CE-CT
 The number of positive items was defined as SPS
from 0 to 3
Utility of SPS for the prediction of
mortality rate
Utility of SPS for predicting infection
and organ dysfunction during the
clinical course
 Optimum Cutoff Level for SPS

 Optimum cutoff level of SPS :1.5

 137 patients were divided into 2 groups by
SPS.
(0,1) and (2,3)
 Mortality rate, Incidence of organ
dysfunction and Incidence of infection were
calculated.
Comparison of the usefulness of
SPS
Comparison of the usefulness of
SPS
Comparison of the usefulness of
SPS
 Conclusion

 SPS is simple and provides sufficient

predictive power to facilitate clinical
decision making.
 Patients with high SPSs(score 2 and 3)
should be treated as patients with extremely
severe disease.
 This scoring system is not suitable for
patients who do not have SAP.
Thank You