Outcome Analysis of APACHE-II Scoring System in Predicting 30 Days Mortality in Acute Pancreatitis in Tertiary Care Hospital
DOI:
https://doi.org/10.51253/pafmj.v75i1.11619Keywords:
APACHE score, Acute mortality, Necrosis, Organ failure, Pancreatitis, PrognosisAbstract
Objective: To evaluate outcome analysis of Apache-II scoring system in predicting 30 days mortality in acute pancreatitis in tertiary care hospital.
Study Design: Prospective longitudinal study.
Place and Duration of Study: Combined Military Hospital Rawalpindi, Pakistan from August 2023 and December 2023.
Methodology: One hundred patients with acute pancreatitis were examined retrospectively. Individuals who met the Ranson criteria or were hospitalized for>2 months were chosen. Mortality, organ failure, and pancreatic necrosis were the primary outcome measures. On the other hand, the occurrence of organ failure was analyzed with a score of Apache II at admission to the hospital.
Results: The 48-hour score was significantly correlated with organ failure (p=0.001), pancreatic necrosis (p<0.01), and mortality (p<0.01). In contrast, organ failure was the only factor with which the score at admission had a significant relationship (p=.007). A fatal outcome had a considerable connection (p=.03) with declining scores over 48 hours. The overall score of Apache II was substantially higher in non-survivors (p<.001) and was highly correlated with organ failure (p<.001) and pancreatic necrosis (p=.001). In contrast to 74% based on the admission score, 92% of patients had their outcomes correctly predicted by the 48-hour and combined scores.
Conclusion: The 48-hour score has a better prognostic value than the admission score in predicting which individuals with severe acute pancreatitis will have a poor prognosis. A declining APACHE II score 48 hours after admission identifies individuals who are at risk for negative results.
Downloads
References
Halonen KI, Pettilä V, Leppäniemi AK, Kemppainen EA, Puolakkainen PA, Haapiainen RK, et al. Multiple organ dysfunction associated with severe acute pancreatitis. Crit Care Med 2002; 30(6): 1274-1279.
https://doi.org/10.1097/00003246-200206000-00019
Dobszai D, Mátrai P, Gyöngyi Z, Csupor D, Bajor J, Erőss B, et al. Body-mass index correlates with severity and mortality in acute pancreatitis: a meta-analysis. World J Gastroenterol 2019; 25(6): 729. https://doi.org/10.3748/wjg.v25.i6.729
Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis. Gastroenterol 2019; 156(7): 2008-2123.
https://doi.org/10.1053/j.gastro.2018.12.04
Goodchild G, Chouhan M, Johnson GJ. Practical guide to the management of acute pancreatitis. Front Gastroenterol 2019; 10(3): 292-299. https://doi.org/10.1136/flgastro-2018-101102
Li S, Zhang Y, Li M, Xie C, Wu H. Serum albumin, a good indicator of persistent organ failure in acute pancreatitis. BMC Gastroenterol 2017; 17: 1-6.
https://doi.org/10.1186/s12876-017-0615-8
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62(1): 102-11.
https://doi.org/10.1177/0004563213480712
Garret C, Péron M, Reignier J, Le Thuaut A, Lascarrou JB, Douane F, et al. Risk factors and outcomes of infected pancreatic necrosis: Retrospective cohort of 148 patients admitted to the ICU for acute pancreatitis. Unit Eur Gastroenterol J 2018; 6(6): 910-918.
https://doi.org/10.1177/2050640618764049
Kuo DC, Rider AC, Estrada P, Kim D, Pillow MT. Acute pancreatitis: what's the score?. J Emerg Med 2015; 48(6): 762-770.
https://doi.org/10.1016/j.jemermed.2015.02.018
Papachristou GI, Muddana V, Yadav D, O'connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. the American Coll Gastroenterol 2010; 105(2): 435-441.
https://doi.org/10.1038/ajg.2009.622
Schuetz P, Christ-Crain M, Muller B. Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections--hope for hype?. Swiss Med Weekly 2009; 139(23): 318.
https://doi.org/10.4414/smw.2009.12584
Siregar GA, Siregar GP. Management of severe acute pancreatitis. Open access Macedon J Med Sci 2019; 7(19): 3319.
https://doi.org/10.3889/oamjms.2019.720
Vijay Ganapathy S, Karthikeyan VS, Sreenivas J, Mallya A, Keshavamurthy R. Validation of APACHE II scoring system at 24 hours after admission as a prognostic tool in urosepsis: A prospective observational study. Invest Clin Urol 2017; 58(6): 453-459.
https://doi.org/10.4111/icu.2017.58.6.453
Donnino MW, Salciccioli JD, Dejam A, Giberson T, Giberson B, Cristia C, et al. APACHE II scoring to predict outcome in post-cardiac arrest. Resuscitation 2013; 84(5): 651-656.
https://doi.org/10.1016/j.resuscitation.2012.10.024
Schepers NJ, Bakker OJ, Besselink MG, Ali UA, Bollen TL, Gooszen HG, et al. Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis. Gut 2019; 68(6): 1044-1051.
https://doi.org/10.1136/gutjnl-2017-314657
Papachristou GI, Muddana V, Yadav D, O'connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. American Coll Gastroenterol 2010; 105(2): 435-441.
https://doi.org/10.1038/ajg.2009.622
Harshit Kumar A, Singh Griwan M. A comparison of APACHE II, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification. Gastroenterol Rep 2018; 6(2): 127-131.
https://doi.org/10.1093/gastro/gox029
Jeong S. Scoring systems for the patients of intensive care unit. Acute Crit Care 2018; 33(2): 102.
https://doi.org/10.4266/acc.2018.00185
Saleh A, Ahmed M, Sultan I, Abdel-Lateif A. Comparison of the mortality prediction of different ICU scoring systems (APACHE II and III, SAPS II, and SOFA) in a single-center ICU subpopulation with acute respiratory distress syndrome. Egypt J Chest Dis Tuberculosis. 2015; 64(4): 843-848.
https://doi.org/10.1016/j.ejcdt.2015.05.012
Lee H, Lim CW, Hong HP, Ju JW, Jeon YT, Hwang JW, et al. Efficacy of the APACHE II score at ICU discharge in predicting post-ICU mortality and ICU readmission in critically ill surgical patients. Anaesth Intens Care 2015; 43(2): 175-186.
https://doi.org/10.1177/0310057X1504300206
Edipoglu IS, Dogruel B, Dizi S, Tosun M, Çakar N. The association between the APACHE-II scores and age groups for predicting mortality in an intensive care unit: a retrospective study. Roman J Anaesth Intens Care 2019; 26(1): 53-58.
https://doi.org/10.2478/rjaic-2019-0008
Garcea G, Gouda M, Hebbes C, Ong SL, Neal CP, Dennison AR, et al. Predictors of severity and survival in acute pancreatitis: validation of the efficacy of early warning scores. Pancreas 2008; 37(3): e54-61. https://doi.org/10.1097/MPA.0b013e3181771451
Waller A, Long B, Koyfman A, Gottlieb M. Acute pancreatitis: updates for emergency clinicians. J Emerg Med 2018; 55(6): 769-779. https://doi.org/10.1016/j.jemermed.2018.08.009
Venkataraman R, Gopichandran V, Ranganathan L, Rajagopal S, Abraham BK, Ramakrishnan N, et al. Mortality prediction using acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation IV scoring systems: Is there a difference?. Indian J Crit Care Med 2018; 22(5): 332.
https://doi.org/10.4103/ijccm.IJCCM_422_17
Metri A, Bush N, Singh VK. Predicting the severity of acute pancreatitis: Current approaches and future directions. Surg Open Sci 2024; 19: 109-117.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Muhammad Ajmal Leghari, Waseem Ahmed Khan, Imran Ashraf, Abdul Hameed, Ahmad Tariq, Muhammad Bilal Sikandar Nagra

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.