Comparación entre las escalas Apache II, Bisap y Marshall modificada, en la evaluación de la severidad de la pancreatitis aguda de origen biliar. Hospital Vicente Corral Moscoso. 2018-2019.

Abstract

Background: Acute pancreatitis is a pathology with high morbidity and mortality. To detect its severity there are several scales whose validation criteria are not yet standardized. Objective: To compare the effectiveness of the APACHE, BISAP and MARSHALL scales, in the evaluation of the severity of acute biliary pancreatitis in Hospital Vicente Corral Moscoso 2018-2019. Material and methods: A diagnostic test validation study was carried out based on an analysis of 226 medical records of patients diagnosed with acute pancreatitis. The scales (APACHE, BISAP and MARSHALL) were applied and sensitivity, specificity, positive and negative predictive value, ROC curve, positive and negative likelihood ratio were compared. Results: The mean age was 52.8 ± 20.1 (SD). The female gender predominated 59.7%, mixed ethnicity 88.1% and low socioeconomic status 52.2%. Mild pancreatitis (69.5%) was more frequent than moderate (21.2%) and severe (9.3%). The sensitivity and specificity for the 3 scales was: APACHE II S: 95.2% and E: 80.4%, BISAP S: 71.4% and E: 93.7% and MARSHALL S: 90.5% and E : 76.1% The discriminatory power to predict severity was high with an ACU for APACHE II 0.87, followed by MODIFIED MARSHALL 0.83, and BISAP 0.82. The RVP was better for BISAP 53.57, followed by APACHE 33.3 and MARSALL of 27.94. In contrast, the RVN was better for APACHE II 99.40, then MARSHALL 98.73 and finally for BISAP 96.97.

Conclusions: APACHE, BISAP and MARSHALL, showed similar predictive accuracy to determine the severity of acute pancreatitis.