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External validation of the new Japanese severity score in Turkish patients with acute pancreatitis.

The incidence of acute pancreatitis (AP) has increased during the past 2 decades. Approximately 20% of these patients have a progressive disease, which eventually develops into a severe AP (SAP) along with various serious complications. Multiple organ dysfunction is commonly seen in these patients, with overall mortality rates of approximately 30% to 40%. Thus, early prediction of severity may assist physicians to appropriate therapy. The Japanese Severity Score (JSS) is definitely useful for the prediction of severity in AP and is now used generally in Japan. However, the JSS is very complicated and is not easy to use because it consists of 18 factors. So, a simpler score was needed and the JSS was revised in 2008. The new JSS is composed of 9 prognostic factors. The aim of this study was to evaluate the predictive accuracy of the new JSS in Turkish patients with AP. This retrospective cohort study included 102 consecutive patients with AP during an 18-month period. Of the 102 patients with AP, 43 patients were men and 59 patients were women. The median age of the patients was 56.4 years (range, 17Y89 years). The causes of AP were alcoholic (n = 27), biliary (n = 69), and idiopathic (n = 6) conditions. The diagnosis of AP was based on the clinical manifestation of acute upper abdominal pain associated with a raised serum amylase level greater than 3 times the normal value or with elevated serum lipase levels and radiological evidences compatible with AP. Cases admitted more than 24 hours later than the onset of symptoms were excluded from the study. The main outcomes measured in this study were severity and mortality. We determined the severity of the disease according to the 2012 revision of the Atlanta classification. This classification defines 3 degrees of severity, namely, mild AP, moderately SAP (mSAP), and SAP. Mild AP was defined by the absence of organ failure and the absence of local or systemic complications. Moderately SAP was defined by the presence of transient organ failure or local or systemic complications in the absence of persistent organ failure. Severe AP was defined if it was with persistent organ failure. Three organ systems were assessed to define organ failure, namely, respiratory, cardiovascular, and renal. Organ failure was defined as a score of 2 or more for one of these 3 organ systems using the modified Marshall scoring system. Data related to calculations of the Ranson score and new JSS (Table 1) at admission were collected by a physician unaware of the study end points. We treated patients according to the accepted standard management of AP. The SPSS 11.5 for Windows (Chicago, Ill) was used for statistical analysis. Descriptive statistics were presented as mean (SD). The demographic characteristics of the groups were compared using W and Fisher exact tests and were displayed in cross tables. Group differences were lated by the t test, analysis of variance, Mann-Whitney U test, or Kruskal-Wallis test. We measured the performance of score using receiver operating characteristic (ROC) curves, and the overall performance of the ROC analysis was quantified by computing the area under the curve (AUC) and 95% confidence intervals. An area of 1 indicated perfect performance, whereas 0.5 indicated a performance that was not different than chance. Sensitivity, specificity, as well as positive and negative predictive values are presented for the results of ROC analyses concerning optimal cutoffs. According to the Atlanta criteria, 68 patients were classified as mild AP, 16 patients were classified as mSAP, and 18 patients were classified as SAP. A total of 13 patients (12.7%) died, 10 patients had multiple organ failure, and 3 patients had extensive necrotizing pancreatitis.