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Predictors of Severity and Survival in Acute Pancreatitis: Validation of the Efficacy of Early Warning Scores

Garcea, Giuseppe MD, MRCS; Gouda, Mohammed MBChB; Hebbes, Christopher MBChB; Ong, Seok Ling MBChB, MRCS; Neal, Christopher P. MBChB, MRCS; Dennison, Ashley R. MD, FRCS; Berry, David Paul MD, FRCS

doi: 10.1097/MPA.0b013e3181771451
Online Articles: Original Article

Objectives: Early Warning Scores (EWS) is a widely used scoring system monitoring patient progress, which we have previously shown to predict outcome from acute pancreatitis. This study examined EWS from a larger group of patients to confirm if this predictive value held true.

Methods: The EWS scores were compared with the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, modified organ dysfunction scores, Imrie scores, computed tomography grading scores, and Ranson criteria for 181 admissions with acute pancreatitis. The accuracy of EWS in predicting outcome was determined by receiver operator characteristics.

Results: A total of 181 patients were identified with acute pancreatitis. On day 1 of admission, APACHE II scores were the most accurate predictor of mortality with an area under curve (AUC) values of 0.876, closely followed by EWS (AUC, 0.827). By day 2 and 3 after admission, the EWS was the most accurate predictor of mortality (AUC, 0.910 and 0.934, respectively). The APACHE II was the second most accurate scoring system at 48 and 72 hours (AUC, 0.892 and 0.911, respectively).

Conclusions: The EWSs on days 2 and 3 after admission are sensitive and specific in predicting mortality from acute pancreatitis. It is as accurate as the APACHE II scores and easier to implement in daily practice.

From the Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, United Kingdom.

Received for publication January 3, 2008; accepted March 11, 2008.

Reprints: Giuseppe Garcea, MD, MRCS, Department of Hepatobiliary and Pancreatic Surgery, The Leicester General Hospital, Gwendolen Rd, Leicester, LE5 4PW, United Kingdom (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.