Improved Prediction of Outcome in Patients With Severe Acute Pancreatitis by the APACHE II Score at 48 Hours After Hospital Admission Compared With the APACHE II Score at Admission

Abstract

Hypothesis The 48-hour APACHE (Acute Physiology and Chronic Health Evaluation) II score is a better predictor of pancreatic necrosis, organ failure, and mortality in patients with severe acute pancreatitis than the score at hospital admission. Design A retrospective analysis of 125 patients with acute pancreatitis. Setting A tertiary public teaching hospital. Patients Patients with severe acute pancreatitis as defined by 3 or more Ranson criteria or a hospital stay of longer than 6 days. Main Outcome Measures Pancreatic necrosis, organ failure, and mortality. Results A significant association was found between the 48-hour score and the presence of pancreatic necrosis (P<.001), organ failure (P = .001), and death (P<.001). By contrast, the APACHE II score at admission was significantly associated only with the presence of organ failure (P = .007). Deteriorating APACHE II scores over 48 hours were significantly associated with a fatal outcome (P = .03). The combined APACHE II score (defined as the sum of the admission and 48-hour scores) was significantly higher among nonsurvivors than survivors (P<.001), and was strongly associated with the presence of pancreatic necrosis (P = .001) and organ failure (P<.001). The 48-hour and combined scores accurately predicted outcome in 93% of the patients compared with 75% by the admission score. Conclusions The 48-hour APACHE II score has improved predictive value compared with the admission score for identifying patients with severe acute pancreatitis who have a poor outcome. A deteriorating APACHE II score at 48 hours after admission may identify patients at risk for an adverse outcome.