Patient selection: hospital admission for acute pancreatitis
Parameters:
(1) serum BUN on admission
(2) second BUN at about 24 hours after admission (18 to 30 hours)
change in BUN =
= (second BUN) – (admission BUN)
|
Parameter
|
Finding
|
Points
|
|
admission BUN
|
< 20 mg/dL
|
0
|
|
|
>= 20 mg/dL
|
1
|
|
change in BUN
|
< 0
|
0
|
|
|
>= 0
|
1
|
where:
• The authors refer to a change >= 0 as a rise in the second value. This could also be referred as a failure to fall.
number of risk factors for mortality =
= SUM(points for the 2 measures)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 2
• The odds ratio for the first measure is 4.6 and for the second is 4.3.
The authors developed an algorithm for predicting mortality.
|
Admission BUN
|
Change in BUN
|
Mortality
|
|
< 20 mg/dL
|
< 2 mg/dL
|
0 to 1%
|
|
< 20 mg/dL
|
>= 2 mg/dL
|
7 to 15%
|
|
>= 20 mg/dL
|
< 5 mg/dL
|
0 to 3%
|
|
>= 20 mg/dL
|
>= 5 mg/dL
|
9 to 20%
|
Performance:
• The area under the ROC curve was 0.82 to 0.91.
• It is considered by the authors to be comparable to use of the APACHE II score.
