Review

Prediction of Mortality in Acute Pancreatitis: A Systematic Review of the Published Evidence
G. Gravante, G. Garcea, S.L. Ong, M.S. Metcalfe, D.P. Berry, D.M. Lloyd, A.R. Dennison

Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK

Address of Corresponding Author

Pancreatology 2009;9:601-614 (DOI: 10.1159/000212097)

  Key Words

• Acute pancreatitis
• Mortality
• Morbidity
• Severity
• Prognostic factors
• Scores
• Indexes

  Abstract

Objective: In this review, we focus on studies that examined such prognostic indices in relation to predicting a fatal outcome from pancreatitis. Summary Background Data: Acute pancreatitis (AP) is a common emergency, and early identification of high-risk patients can be difficult. For this reason, a plethora of different prognostic variables and scoring systems have been assessed to see if they can reliably predict the severity of pancreatitis and/or subsequent mortality. Methods: All studies that focused on AP, including retrospective series and prospective trials, were retrieved and analysed for factors that could influence mortality. Articles that analysed factors influencing the severity of the disease or the manifestation of disease-related complications were excluded. Results: 58 articles meeting the inclusion criteria were identified. Among the various factors investigated, APACHE II seemed to have the highest positive predictive value (69%). However, most prognostic variables and scores showed high negative predictive values but suboptimal values for positive predictive power. Conclusions: Despite the proliferation of scoring systems for grading AP, none are ideal for the prediction of mortality. With the exception of the APACHE II, the other scores and indexes do not have a high degree of sensitivity, specificity and predictive values.

Copyright © 2009 S. Karger AG, Basel and IAP

  Author Contacts

Giuseppe Garcea
Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital
Gwendolen Road, Leicester LE5 4PW (UK)
E-Mail gg43@le.ac.uk

  Article Information

Published online: August 4, 2009
Number of Print Pages : 14
Number of Figures : 2, Number of Tables : 4, Number of References : 77