Is the use of specific scoring system still justified in early evaluation of acute pancreatitis?

Study aim: Acute pancreatitis (AP) is a potentialy life-threatening disease in which specific severity scoring system has been developed. The aim of this prospective study was to compare efficiency of the general severity of illness scoring system and the most widely used specific scoring system of AP in order to simplify the initial monitoring of AP at the time of admission. Patients and methods: Eighty-seven patients with AP were hospitalized in the same center. There were 47 men and 40 women (mean age: 57 +/- 16 years). Specific scores (Ranson, Imrie, Blarney) and general severity of illness scores (SAPSI, SAPS II, Apache II) were calculated for each patient. Radiological scores (Hill, Balthazar) were also calculated when TDM was early performed (80 %). Each scoring system was correlated with severity, morbidity and mortality of AP and its predictive value evaluated by the area under the ROC curve. Results: Aetiology of AP was predominantly biliary (20 %) and alcoholic (70 %). Eight per cent of the patients died and 29 % of AP were classified as severe according to the Atlanta Congress Score. Morbidity rate was 40 %. All the scoring systems were significantly correlated with mortality and exhibit ROC curve area between 0.77 and 0.84, resulting in a similar prediction of death. Conclusion: Specific scoring system and general severity of illness scoring system have the same predictive efficiency in acute pancreatitis. The use of the specificity scoring system seems to be no more justified in acute pancreatitis. (C) 2000 Editions scientifiques et medicales Elsevier SAS.