Background

Acute pancreatitis can be a severe disease with a significant impact on patients’ quality of life and outcome. The clinical course is variable and predictive scoring systems have a debated role in early prognosis. This study aims to compare the prognostic accuracy of Balthazar, BISAP, HAPS and SOFA scores in the prediction of in-hospital mortality in patients with acute pancreatitis.

Material and methods

This is a retrospective, single-center cohort study conducted in the Emergency Department of a third-level university hospital. Patients aged >18 years admitted from 01/01/2018 to 31/12/2021 for the first episode of acute pancreatitis were included.

Results

385 patients (mean age of 65.4 years and 1.8% in-hospital mortality) were studied. Balthazar, BISAP and SOFA scores were significantly higher in patients with in-hospital mortality and AUROCs were equal to 0.95, (95% IC 0.91-0.99, p <0.001), 0.96 (95% CI 0.89-1, p = 0.001), 0.91 (95% CI 0.81-1, p = 0.001) with no differences among them. At their best cut-off values, Balthazar > 2 showed 100% sensitivity (95% CI 59 – 100) and 100% NPV (95% CI 98.8 – 100); HAPS > 0 showed 100% sensitivity (95% CI 59 – 100) and 100% NPV (95% CI 97.6 – 100); SOFA score > 6 showed 96.72% specificity (95% CI 93.6 - 98.6) and 99.2% PPV (95% CI 97 - 99.9); BISAP score showed 85.71% sensitivity (95% CI 42.1 - 99.6) and 92.43% specificity (95% CI 89.2 - 94.9). At the multivariate analysis, significant independent predictors of in-hospital mortality were: only the percentage of pancreatic necrosis for Balthazar score (OR 34, [95% CI 1.43-830] (p= 0.03); an impaired mental status for BISAP score (OR 218 [95% CI 14-3343] (p< 0.001); both peritonitis and creatinine >2 mg/dL for HAPS (OR 43 [95% CI 4.57-410] and 75.8 [95% CI 6.44-892], respectively. No items of the SOFA score proved to be significant independent predictors.

Conclusions

AP is a potentially serious disease with high clinical variability. As demonstrated, comorbidities play a fundamental role in short-term prognosis as well as advanced age, presentation to the ED with abnormal mental status, acute abdomen, high urea and creatinine blood levels, and areas of pancreatic necrosis detected at CT. Although heterogeneous, clinical risk scores measure / predict different clinical aspects of AP: HAPS is just a simple rule that may be effective in identifying patients with very low IHM risk; Balthazar measures the severity of AP from a radiological point of view, with high sensitivity for IHM; SOFA assesses the degree of multi-organ failure with high specificity for IHM and BISAP score, although it was specifically designed to measure the clinical severity of AP and predict IHM, its global accuracy was no significantly different than that exhibited by Balthazar and SOFA scores.