Comparative evaluation of various scoring systems to predict prognosis in patients with acute biliary pancreatitis

Acute pancreatitis is a heterogeneous group of diseases; may show a mild or severe course. Therefore, it is very important to define the severity of the disease and to predict its course at the time of admission. There are multiple scoring systems for this purpose. However, it can be said that there is not a single ideal scoring system. Almost all scoring systems often focus on the development of severe pancreatitis, pancreatic necrosis, organ failure or death. There are limited studies in the literature about the concepts that may affect prognosis such as the development of comorbid cholangitis, the need for narcotic analgesic and duration of hospital stay. In this study, we aimed to evaluate the compliance of clinical and laboratory findings and prognostic scores with Revised Atlanta Criteria in patients presenting with acute biliary pancreatitis and to reveal the relationship of all these factors with cholangitis development, narcotic analgesic need and duration of hospital stay. In this study, patients with acute biliary pancreatitis were evaluated retrospectively at the Gastroenterology Department of Akdeniz University Medical Faculty Hospital between January 2018 and December 2018. Demographic, clinical and laboratory data of the patients were retrospectively obtained from patient files and hospital information system. Patients were evaluated according to the revised Atlanta classification. Scoring systems Ranson, Glasgow-Imrie, BISAP, HAPS APACHE and SOFA scores were evaluated. The Atlanta classification was moderately correlated with the BISAP and Glasgow-Imrie scores, while the HAPS score was slightly correlated. The HAPS and BISAP scores correlated well with each other, while the BISAP and Glasgow-Imrie scores were moderately correlated. In patients with HAPS, BISAP and Glasgow-Imrie positive patients, cholangitis and the use of broad-spectrum antibiotics are more common, as in patients with moderate or severe pancreatitis according to Atlanta classification. As a result, the duration of hospitalization was longer and the need for narcotic analgesics was higher due to pain persistence. In addition, 48-hour acute phase responses were significantly higher. There was no significant relationship between Ranson, SOFA and APACHE scores and the clinical and follow-up data of the patients and laboratory results. As for laboratory findings, 48-hour neutrophil lymphocyte ratio was found to be correlated with the severity of pancreatitis as well as cholangitis development, narcotic analgesic requirement and hospital stay. There may not be a single ideal scoring system in predicting the severity of pancreatitis. A combination of multiple scoring or laboratory data may increase the sensitivity and specificity of clinical decisions; Further studies aiming at other prognostic factors, such as the development of cholangitis and duration of hospitalization other than the severity of pancreatitis, are required.