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The Early Prediction of Mortality in Acute Pancreatitis: A Large Population-based Study
  1. Bechien U Wu (buwu{at}partners.org)
  1. Brigham and Women's Hospital, United States
    1. Richard S. Johannes (rjohannes{at}partners.org)
    1. Brigham and Women's Hospital, United States
      1. Xiaowu Sun (xiaowu.sun{at}cardinal.com)
      1. Cardinal Health, United States
        1. Ying Tabak (ying.tabak{at}cardinal.com)
        1. Cardinal Health, United States
          1. Darwin L. Conwell (dconwell{at}partners.org)
          1. Brigham and Women's Hospital, United States
            1. Peter A. Banks (pabanks{at}partners.org)
            1. Brigham and Women's Hospital, United States

              Abstract

              Background: Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step to improving outcome.

              Methods: Using Classification and Regression Tree (CART) analysis, we developed a clinical scoring system for prediction of in-hospital mortality in AP. We derived the scoring system on data collected from 17,992 cases of AP from 212 hospitals in 2000-2001. We validated the new scoring system on data collected from 18,256 AP cases from 177 hospitals in 2004-2005. Accuracy of the scoring system for prediction of mortality was measured by the area-under the receiver-operating curve (AUC). We further validated the performance of the new scoring system by comparing its predictive accuracy to APACHE II.

              Results: CART analysis identified five variables for prediction of in-hospital mortality. One point is assigned for the presence of each of the following during the first 24 hours: BUN>25 mg/dL, Impaired mental status, SIRS, age>60 years or the presence of a Pleural effusion (BISAP). Mortality ranged from >20% in the highest risk group to <1% in the lowest risk group. In the validation cohort, the BISAP AUC was 0.82 [95% CI 0.79, 0.84] vs. APACHE II AUC of 0.83 [95% CI 0.80, 0.85].

              Conclusions: We have derived and validated a new mortality-based prognostic scoring system for use in acute pancreatitis. The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality.

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