A COMPARATIVE STUDY: RANSON'S CRITERIA AND MODIFIED COMPUTED TOMOGRAPHY SEVERITY INDEX FOR PROGNOSIS PREDICTION IN ACUTE PANCREATITIS
Main Article Content
Keywords
Acute Pancreatitis, Ranson Criteria, MCTSI, CTSI, Pancreatic Necrosis, Pancreatic Complication
Abstract
Background: Acute pancreatitis is an inflammatory condition of the pancreas that can range in severity from mild to life-threatening. Early identification of high-risk patients is critical, as they often need intensive care and aggressive treatment. Scoring systems like Ranson's criteria and the Modified Computed Tomography Severity Index (CTSI) help predict severity and prognosis. Ranson's criteria evaluates eleven parameters, with higher scores indicating greater mortality risk. The Modified CTSI uses CT imaging for objective assessment of pancreatic damage.
Methods: A cross-sectional study of 60 adults with acute pancreatitis compared Ranson's criteria and modified CTSI for prognostic accuracy. Data from medical records included demographics, clinical findings, scores, and outcomes. Exclusions were chronic pancreatitis, trauma, or surgery. Outcomes assessed included necrosis, organ failure, ICU need, and mortality.
Results: The study evaluated 60 acute pancreatitis patients, analyzing clinical features, CT findings, and scoring systems. MCTSI showed high predictive value for pancreatic necrosis (AUC 0.943, sensitivity 100%), while Ranson’s score at 48 hours was more accurate for severity (AUC 0.884) and mortality (AUC 0.828). Ranson’s score had higher sensitivity and specificity for mortality, while MCTSI was superior in detecting necrosis. Overall, each score demonstrated strengths in different clinical outcomes, highlighting the importance of context-based application.
Conclusion: The study compares the Ranson criteria and the Modified Computed Tomography Severity Index (MCTSI) in predicting outcomes for acute pancreatitis. The Ranson score is effective for predicting early mortality, whereas the MCTSI better detects local complications like pancreatic necrosis. Using both scores together may improve the evaluation of severity and patient outcomes.
References
[2] Johnson CD, Besselink MG, Carter R, et al. Acute pancreatitis. 2017;20(7):381. Available from: https://doi.org/10.3760/cma.j.issn.1007-9742.2017.07.113
[3] Akshatha HS, Sachin MB, Vaggara HB. Demographic profiles, etiology and management of patients presenting with acute pancreatitis in AIMS, B. G. Nagara: a prospective study. International Surgery Journal 2021;8(3):889.
[4] Forsmark CE, Baillie J. AGA institute technical review on acute pancreatitis. Gastroenterology 2007;132(5):2022-44.
[5] Blamey S, Imrie CW, O’Neill J, et al. Prognostic factors in acute pancreatitis. Gut 1984;25(12):1340-6.
[6] Weisgarber C, Hughes P. What scoring system best predicts morbidity and mortality from acute pancreatitis? Evidence-Based Practice 2019;22(4):19-20.
[7] Imrie CW. Prognostic indicators in acute pancreatitis. Canadian Journal of Gastroenterology and Hepatology 2003;17(5):325-8.
[8] Larvin M, Mcmahon M. APACHE-II score for assessment and monitoring of acute pancreatitis. The Lancet 1989;334(8656):201-5.
[9] Thiyagarajan UM, Ponnuswamy A, Thomas R, et al. Can inflammatory markers foretell aetiology and prolonged hospitalisation in acute pancreatitis? Cureus 2021;13(1).
[10] Alam M, Agrawal P, Singh RK, et al. Comparative assessment of severity and prognosis of acute pancreatitis through APACHE II and HAPS predictor models. International Journal of Research in Medical Sciences 2021;9(4):994.
[11] Luo X, Wang J, Wu Q, et al. A modified Ranson score to predict disease severity, organ failure, pancreatic necrosis, and pancreatic infection in patients with acute pancreatitis. Frontiers in Medicine 2023;10:1145471.
[12] Meza-Franco JC, Pedraza-Zárate MÁ, Solis-Pureco JP, et al. Prognostic Evaluation Between Apache II Scale and Ranson Scale in Severe Acute Pancreatitis in the Emergency Department. Prevalence 2020;96(91.29):100.
[13] Miller J, Wu Y, Safa R, et al. Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study. BMC Emergency Medicine 2021;21(1).
[14] Goel KS, Garg G, Singla S. Evaluation of clinical profile of acute pancreatitis in a tertiary centre. International Surgery Journal 2021;8(2):583.
[15] Ong Y, Shelat VG. Ranson score to stratify severity in acute pancreatitis remains valid – old is gold. Expert Review of Gastroenterology & Hepatology Taylor & Francis 2021;15(8):865.
[16] Cofaru FA, Nica S, FierbinȚeanu-Braticevici CA. Assessment of severity of acute pancreatitis over time. Rom J Intern Med 2020;58(2):47-54.
[17] Matull W, Pereira SP, O’Donohue J. Biochemical markers of acute pancreatitis. Journal of Clinical Pathology. BMJ 2006;59(4):340-4.
[18] Khanna A, Meher S, Prakash S, et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis. HPB Surgery 2013;2013(1):367581.
[19] Deng H, Yu X, Gao K, et al. Dynamic nomogram for predicting thrombocytopenia in adults with acute pancreatitis. Journal of Inflammation Research 2021:6657-67.
[20] Ali H, Bolick NL, Tillmann H. Simple scoring for acute necrotizing pancreatitis: mortality in acute necrotizing pancreatitis during admission (MANP-A). Annals of Gastroenterology 2022;35(5):551.
[21] Taylor SL, Morgan DL, Denson KD, et al. A comparison of the Ranson, Glasgow, and APACHE II scoring systems to a multiple organ system score in predicting patient outcome in pancreatitis. The American Journal of Surgery 2005;189(2):219-22.
[22] Mok S, Judge T, Elfant A, et al. The APACHEIV: A new scoring system for predicting mortality and complications of severe acute pancreatitis: 205. Official Journal of the American College of Gastroenterology 2014;109:S63.
[23] Sarr MG, Banks PA, Bollen TL, et al. The new revised classification of acute pancreatitis 2012. Surgical Clinics of North America 2013;93(3):549-62.
[24] Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology 2012;262(3):751-64.
[25] Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut 2012;62(1):102-11.
[26] Wilson C, Heath D, Imrie CW. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg 1990;77(11):1260-4.
[27] Quintairos A, Pilcher D, Salluh JI. ICU scoring systems. Intensive Care Medicine 2022;49(2):223-5.
[28] Rawla P, Bandaru SS, Vellipuram AR. Review of infectious etiology of acute pancreatitis. Gastroenterology Research 2017;10(3):153.
[29] Mukherjee D, Bhakta S, Lahiry S, et al. Demographic profile of acute pancreatitis in Eastern India: a single centre experience. Asian Journal of Medical Sciences 2017;8(6):24-9.
[30] Bhatia M. Inflammatory response on the pancreatic acinar cell injury. Scandinavian Journal of Surgery. 2005;94(2):97-102.
[31] Feng YC, Wang M, Zhu F, et al. Study on acute recent stage pancreatitis. World Journal of Gastroenterology: WJG 2014;20(43):16138.
[32] Kozieł D, Kozłowska M, Deneka J, et al. Retrospective analysis of clinical problems concerning acute pancreatitis in one treatment center. Gastroenterology Review/Przegląd Gastroenterologiczny 2013;8(5):320-6.
[33] Aipe AK, Janardhanan R, Paul D. A clinical profile of acute pancreatitis in a tertiary hospital in South India. International Journal of Surgery Science 2020;4(4):1-3.
[34] Bollen TL, Singh VK, Maurer R, et al. A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. Official Journal of the American College of Gastroenterology 2012;107(4):612-9.
[35] Wu BU, Johannes RS, Sun X, et al. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut 2008;57(12):1698-703.
[36] Narayanswamy T, Supreeth K, Sridhar G. A double blinded comparative study between omega 3 fatty acid infusion versus octreotide infusion in acute pancreatitis. International Surgery Journal 2020;7(10):3251.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Ashrathi B
Postgraduate, Department of General Surgery, AJ Institute of Medical Sciences and Research Center, Mangalore, Karnataka, India.
Dr. Kalpana Shridhar Murulya
Professor, Department of General Surgery, AJ Institute of Medical Sciences and Research Center, Mangalore, Karnataka, India.