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Applying Ockham's Razor to Pancreatitis Prognostication: A Four-Variable Predictive Model

Spitzer, Austin L. MD*†; Barcia, Anthony M. BS*; Schell, Michael T. MD*; Barber, Annabel MD‡; Norman, James MD§; Grendell, James MD∥; Harris, Hobart W. MD, MPH*

doi: 10.1097/01.sla.0000202213.22389.36
Original Articles

Objective: We sought to develop a simple yet accurate prognostic scoring system to determine the severity of acute pancreatitis at admission.

Summary Background Data: Because acute pancreatitis has a variable and frequently unpredictable course, identifying individuals at greatest risk for significant, life-threatening complications and stratifying their care appropriately remain a concern. Previous prognostic scoring systems predict severity reasonably well but are limited by time constraints, are unwieldy to use, or both.

Methods: Data from the international phase III trial of the platelet-activating factor receptor-antagonist Lexipafant were used to develop a 4-variable prognostic model. We then compared the model's ability to predict the severity of acute pancreatitis with the Ranson, Glasgow, and APACHE II systems.

Results: The model (BALI), which included BUN ≥25 mg/dL, Age ≥65 years, LDH ≥300 IU/L, and IL-6 ≥300 pg/mL, measured at admission, was similar to the Ranson, Glasgow, and APACHE II systems in its ability to identify increased mortality from acute pancreatitis. The receiver operating characteristic curve area for the BALI model was ≥0.82 ± 0.03 (mean ± SD) versus 0.75 ± 0.04 (Ranson), 0.80 ± 0.03 (Glasgow), and 0.79 ± 0.03 (APACHE II). Furthermore, at a prevalence of 15%, the positive and negative predictive values for increased mortality were similar for all systems.

Conclusion: The prognostic ability of the BALI 4-variable model was similar to the Ranson, Glasgow, and APACHE II systems but is unique in its simplicity and ability to accurately predict disease severity when used at admission or anytime during the first 48 hours of hospitalization.

Data from the international Lexipafant trial was used to develop a prognostic model that could identify patients with an increased risk of mortality from acute pancreatitis. The model, which included BUN, age, LDH, and IL-6, is unique in its simplicity and ability to predict severity of acute pancreatitis at admission.

From the *Department of Surgery, University of California-San Francisco, San Francisco, CA; and †Department of Surgery, University of California-East Bay, East Bay, CA; ‡Department of Surgery, University of Nevada, Las Vegas, NV; §Department of Surgery, University of South Florida, Tampa, FL; and ∥Department of Surgery, New York Hospital-Cornell Medical Center, New York, NY.

Reprints: Hobart W. Harris, MD, MPH, Division of General Surgery, University of California-San Francisco, 513 Parnassus Avenue, S-301, San Francisco, CA 94143-0104. E-mail: harrish@surgery.ucsf.edu.

© 2006 Lippincott Williams & Wilkins, Inc.