with varying involvement other regional tissues or remote organ systems. About 80%of attacks are mild, 20% are severe and they are commonly accompanied by necrosis of the pancreas or organ failure. Gallstones and chronic ethanol abuse account for 70% of cases of acute pancreatitis. Pathologically there are two types of pancreatitis- interstitial and necrotizing [1].

Assessment of severity of acute pancreatitis is important for early identification of patients who may benefit from additional supportive and specific therapeutic procedures. Pancreas is a retroperitoneal organ and it lies behind the stomach, transversecolon and the mesocolon. It extends from the medial head of the duodenal Cloop to the hilum of spleen, lies anterior to the inferior venacava, aorta, and splenicveinand leftadrenalgland [2].

The whole organ measures over 15cm long weighs about 90 to 120g in adult, soft in consistency with lobulated surface (hence called as lady of abdomen). It occupies the supracolic and partly the in fracolic compartment[3-4].

The duct of Wirsung is the major duct comes from the tail to the head, arisesfrom the confluence of numerous small ducts of the lobules crossing the gland for minga “Herringbone” pattern, gradually increasing in diameter up to 10mm which joins with the common bile duct in adilatation called “AMPULLAOFVATER” which in turn opens into the duo denalpapilla [5].

The duct of Santorini drains the uncinated process and lower part of the head of pancreas lies more on ventral plane, opens into the duodenum 2 cmproximal to the major papilla and 7 cm distal to the pylorus. Injury to the duct of Santorini in the pancreatic divisum during gastrectomy results in severe hemorrhagic or recurrent pancreatitis [6-7].

Study Design: Observational Study.

A total of 110 Patients admitted in department of General Surgery, Gadag Institute of Medical Science, Gadag during the period of 01 Year was be taken for study considering the inclusion and exclusion criteria.

• Data was be collected through proforma.
• Patients was be assessed by adequate history, thorough examinations and investigations.
• Blood samples for determination of blood sugar levels, Total leucocyte count, Serum amylase, Alanine amino transferase, Lactate dehydrogenase, Hematocrit levels, Blood urea, nitrogen, Serum calcium, Arterial blood gas analysis, Computed tomography

Inclusion Criteria

Patients with confirmed diagnosis of acute pancreatitis based on clinical suspicion and elevated serum amylase in the age group of 16 to 70 years.

Exclusion Criteria

• Patients with chronic pancreatitis.
• Patients with acute on chronic pancreatitis.
• Hyperamylasemia due to other causes.

Methods of Statistical Analysis

The data was be entered in excel format analyzed using the statistical software SPSS 22 version and then the results was be calculated using the descriptive statistics like mean, standard deviation, chi square test to be used for association between factors and P- value, Spearman rank correlation analysis used for each pair of scoring systems.

Table no: 1 Age distribution of study population

• Total number of patients studied were 110.
• According to the Atlanta Criteria, 69 patients(62.73%)wereclassifiedasMildAcute Pancreatitis and 41 (37.27%) patients were classified as Severe Acute Pancreatitis.
• Of the110 patients, 70 patient shada Ranson’s score of less than or equal to 3, 40 patients had a Ranson’s greater than3.
• Of the 110 patients, 73 patients had an Apache II score of less than or equal to 8,37 patients had an Apache II score of greater than 8.

Table 2:  Complications wise distribution of patients

Of the local complications, 18 patients (16.36%) developed Pseudo Cyst, 17patients (15.45%) developed pancreatic necrosis, and 6 patients (5.45%) developed hemorrhagicpancreatitis.

Surgicalinterventionswereperformedin5patients.

Table 3: Prediction of severity of Ranson’s scores

Ranson’s score of greater than or equal to 3 predicted a greater number of severe attacks (100%) but a smaller number of mild attacks (37.68%) with PPV of 48.81 and NPVof100andaccuracyof60.91.

Ranson’s score of greater than or equal to 5 predicted less number of severe attack (63.41%) and branded more severe attacks as mild attacks. Ranson’s score of greater than or equal to 4 had the best sensitivity, specificity and accuracy.

Table 4: Prediction of severity of Apache II scores

APACHE II score of greater than or equal to 9 predicted 87.8% of severe attacks and 98.55% of mild attacks with a PPV of 97.30 and NPV of 93.15 and accuracy of 94.55

APACHE II score of greater than or equal to 8 predicted more number of severe attacks (97.56%) but less number of mild attacks (85.51%) with PPV of 80.0 and NPV of 98.33.

Table 5: Prediction of severity of Ranson’s and Apache II scores

As Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy are nearly found to be same for Ranson’s and APACHE II scores, Ranson’s scoring system is equally efficacious as APACHE II scoring system in the prognostication of acute pancreatitis.

Acute Pancreatitis is an increasing common abdominal emergency. Assessment of severity of acute pancreatitis is important for early identification of patients who may benefit from additional supportive and specific therapeutic procedures[8-9]. Many different scoring systems have been devised for the assessment of severity of acute pancreatitis, which are divided into two types: The first type attempts to correlate laboratory and clinical markers specific to pancreatitis with subsequent outcome and disease severity, the most widely used in this group is Ranson’s Score. The second type of scoring system is the application of non-specific physiological                 scoring system, which was originally created for use in general population of critically ill patients like APACHEII scores[10].

Ideal predicting criteria should be simple, non-invasive, accurate and quantitative; and the assessment tests should be readily available at the time of diagnosis. The results of the studies were: I) Two early risk factors for death were identified: increasing age and hypotension at admission. Deaths were to a high extent related to multiple organ dysfunction[11-12]. Early recurrence after biliary acute pancreatitis was common. II) A model for early prediction of severity in acute pancreatitis with artificial neural networks was developed, identifying risk factors. Severe acute pancreatitis usually declares itself shortly after the onset of symptoms and delayed progression from mild to severe disease is uncommon. Assessment of the severity of acute pancreatitis is important for early identification of patients who may benefit from additional supportive and specific therapeutic procedures[13]. It is also important to standardize clinical data for comparison of results between centers. Ideal predicting criteria should, therefore, be simple, non-invasive, accurate and quantitative, and the assessment tests should be readily available at the time of diagnosis. Amongst the multifactorial scoring systems, Ranson system is classical through the Apache II system appears to provide the best accuracy[14].

The Ranson’s scoring system accurately predicts the outcome in patients with acute pancreatitis and compares favorably with the physiological scoring systems in the prediction of disease severity for acute pancreatitis, the only disadvantage being a 24-hour delay.

The Ranson’s scoring system proved to be as powerful a prognostic model as the more complicated APACHE II scoring system even in the present era of advanced investigations. The study included 110 patients with acute pancreatitis, peak incidence was in the fourth decade with alcohol accounting for maximum attacks.

An APACHE II score of ≥ 10 on admission predicted a complicated outcome in patients with acute pancreatitis with a sensitivity of 100%, specificity of 80%, the positive predictive value of 62% and negative predictive value of 100%. Scores below 10 predicted an uncomplicated outcome.

1. PaÂrniczky A, Kui B, Szentesi A, BalaÂzsA,SzűcsAÂ, Mosztbacher D, etal. (2016) Prospective, Multicentre, Nationwide Clinical Data from 600 Casesof Acute Pancreatitis. PLoSOne 11(10):e0165309.doi:https://doi.org/10.1371/journal.pone.0165309.
2. Umamani Subramaniam, Ahila Muthuselvi, Kesavan; A comparative study between APACHE II and Ranson scoring system in predicting the severity ofacute pancreatitis. International Archives of Integrated Medicine, Volume6,Issue4,April2019
3. Thomas L Bollen et al; A Comparative Evaluation of Radiologic and Clinical Scoring Systems in the Early Prediction of Severity in Acute Pancreatitis. The American Journal of Gastroenterology. 2012 Apr; 107: 612-619.
4. Rawad Mounzer et al; Comparison of Existing Clinical Scoring Systems toPredict Persistent Organ Failure in Patients With Acute Pancreatitis. JGastoenterology.2012 Mar;50-85.
5. Fabre A et al; Severity scores in children acute pancreatitis. J Pediatr Gastroenterol Nutr. 2012 Mar20.
6. Zhang WW et al; Correlative analysis between CT pancreatic inflammatory infiltration degree and clinical disease severity of severe acute pancreatitis Sichuan Da XueXueBaoYiXueBan. 2011Sep;42(5):699-703.
7. Chatzicoastas C, Roussomoustakaki M, VardasE,RomanosJ,Kouromalis EA.Balthazar computed tomography severity indexis superior to Ranson criteriaand APACHE II and III scoring syestems in predicting acute pancreatitisoutcome.JClinGasteroenterol2003;36:253;260.
8. McKay CJ, Butter A. Natural history of organ failure in acute pancreatitis. Pancreatology, 2003; 3: 111.
9. Scoring syestems in acute pancreatitis.Pancreas.2002 November ;25(4):331-5
10. Chatzicoastas C, Roussomoustakaki M, VardasE, RomanosJ, Kouromalis EA. Balthazar computed tomography severity indexis superior to Ranson criteriaand APACHE II and III scoring syestems in predicting acute pancreatitisoutcome.JClinGasteroenterol2003;36:253;260.
11. McKay CJ, Butter A. Natural history of organ failure in acute pancreatitis. Pancreatology, 2003; 3: 111.
12. Chavarría Herbozo C Metal; Hemoconcentration, APACHEII and Ranson as early predictors of severity in patients with acute pancreatitis in a hospital in Lima-Peru Rev Gastroenterol Peru.2011Jan-Mar;31(1):26-31.
13. Yuk Pang etal; APACHEII is more accurate in predicting severity than Ranson’s score. Hepatobiliary Pancreat DisInt. 2006 Vol.5, No.2, 294-299.
14. Taylor SLetal; Acomparison of the Ranson’s, Glasgow, and APACHEII scoring systems to a multiple organ system score in predicting patient outcome in pancreatitis. AmJSurg.2005Feb;189(2):219-22.