Pusat Pengajian Sains Perubatan - Tesis

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Browsing Pusat Pengajian Sains Perubatan - Tesis by Subject "Acute pancreatitis"

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    A retrospective review of ranson score versus apache-ii score in predicting outcomes of acute pancreatitis in Hospital Universiti Sains Malaysia.
    (2013)
    Mokhter, Wan Muhamad Mokhzani Wan Muhamad
    Acute pancreatitis is a common and potentially lethal inflammatory process with a highly variable clinical course. Persistent organ failure develops in 10-20% of patients, with mortality reaching 30% in this subgroup. It is therefore important to identify patients with acute pancreatitis who are at risk for developing persistent organ failure early in the course of the disease. Ranson score and APACHE-II system are two of the many scoring systems utilized for predicting acute pancreatitis with adverse outcomes. The present study is aimed at assessing both scoring system for its sensitivity, specificity, PPV, NPV and comparing them using the relevant statistical tools to assess and determine which system is better at predicting outcomes of patients with acute pancreatitis presenting to Hospital Universiti Sains Malaysia between 2007 to 2011. Case notes of 156 patients with acute pancreatitis were reviewed retrospectively, Ranson score and APACHE-II score are assigned according to the relevant parameters and outcome is documented for each case. Ranson score is categorically assigned as mild (score less than 3) or severe (score equal to or more than 3) and APACHE-II score as mild (score less than 10) or severe (score equal to or more thanlO). Outcome is also categorically assigned as good (patient discharged from hospital) or poor (patient requires ICU admission, intervention either surgical or radiological and death). Chi-squared test was used to determine association of each test with outcomes and kappa-test was applied to determine strength of relationship for each test with outcomes of acute pancreatitis. Both Ranson score equal to or more than 3 and APACHE-II score equal to or more than 10 are associated with poor outcome of acute pancreatitis in the study cohort (p<0.01). The sensitivity and specificity for Ranson score or equal to or more than 3 is 94.1% and 68.3% respectively (PPV 26.7%. NPV 99.0%). The sensitivity and specificity for APACHE-II score equal to or more than 10 is 70.6% and 90.6% respectively (PPV 48.0%, NPV 96.2%). The kappa value for Ranson score is 0.30 (fair relationship) and kappa value for APACHE-II score is 0.51 (moderate relationship).
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    Publication
    Review of the applicability of the glasgow score versus the ranson score in predicting the severity of acute pancreatitis in Hospital Universiti Sains Malaysia.
    (2013)
    Mohsin, Syed Hasanul-Hadi Syed
    Acute pancreatitis is a fairly common disease managed by most surgical units. Though a vast majority of patients undergo a mild disease course, up to 25% of patients may suffer from a severe attack, leading to persistent organ failure requiring intensive care. Furthermore, up to another 10-15% may succumb to their disease. As such, it is imperative to determine which patients would need early intensive care to guide management. The Ranson score and Glasgow score are two physiological multiple parameter scoring systems widely used in risk stratification. This study aims to identify which scoring system is better suited at predicting outcomes in patients with acute pancreatitis in HUSM from 2007 to 2011. All patients with acute pancreatitis fulfilling the inclusion criteria were reviewed retrospectively. The Ranson scores documented were noted and the Glasgow score was then calculated based on each patients parameters. Both the Ranson and Glasgow score was categorized as mild if the score was less than 3 or severe if the score was more than 3. Outcomes was categorized as good if the patients were discharged well from hospital, or poor if the patients required ventilation in ICU, either surgical or radiological intervention and death. Chi-squared test was used to determine the association of each test and the sensitivity, specificity, PPV and NPV were determined to see which test was better. 156 patients were included in the study. The Ranson score, which has been in practice in HUSM its inception in the mid-eighties, in this study has yielded a sensitivity of 94.1%, and a specificity of 68.3% (PPV 26.6% and NPV 98.9%). The Glasgow score showed a sensitivity of 88.2% and a specificity of 79.9%, with a PPV of 34.9% and NPV of 98.2%, which were all statistically significant (confidence interval < 0.01). Head to head, the Ranson score in this study has proven to be more sensitive, but less specific. The Glasgow score despite being less sensitive, has proven to be more specific and has a better positive predictive value in risk stratification of patients with severe acute pancreatitis in the local setting. Furthermore the score is simple to use and does not require cumbersome calculations or repeated blood investigations.