Prediction of Outcome in Acute Pancreatitis by the qSOFA and the New ERAP Score

Background Early identification of patients with acute severe pancreatitis is important for prompt and adequate treatment. Existing scores for pancreatitis are often laborious or require serial patient evaluation, whereas the qSOFA score, that was established to predict outcome in patients with suspected infection, is simple to perform. Aims and Methods In this cohort study, we analyse the potential of the qSOFA score to predict outcome of patients with acute pancreatitis and refine the qSOFA score by rapid available laboratory parameters to the emergency room assessment of acute pancreatitis (ERAP) score. Validation was performed in a separate patient cohort. Results In total 203 patients with acute pancreatitis were recruited. The qSOFA score has the potential to predict ICU admission (AUC = 0.730, p = 0.002) and organ failure (AUC = 0.799, p = 0.013) in acute pancreatitis. Respiratory rate, mental status, blood urea nitrogen and C-reactive protein are the rapid available parameters with the highest individual impact in binary logistic regression analyses. Their combination to the ERAP score can predict severity of acute pancreatitis according to the revised Atlanta classification (AUC = 0.689 +/- 0.041, p < 0.001), ICU admission (AUC = 0.789 +/- 0.067, p < 0.001), multi-organ dysfunction syndrome (AUC = 0.963 +/- 0.024, p < 0.001) and mortality (AUC = 0.952 +/- 0.028, p = 0.001). The performance and prognostic validity for organ failure and mortality were validated in an independent patient cohort. Conclusion The qSOFA is a rapidly available prognostic score in acute pancreatitis with limited prognostic validity. A combination with the laboratory parameters BUN and CRP results in the new ERAP score with outstanding prognostic validity for multi-organ dysfunction syndrome and mortality.

Automated summary

The qSOFA score shows potential in predicting ICU admission and organ failure in acute pancreatitis. By combining respiratory rate, mental status, blood urea nitrogen, and C-reactive protein into the ERAP score, it can accurately predict severity, ICU admission, multi-organ dysfunction syndrome, and mortality in acute pancreatitis.