Prognostic Evaluation Between Apache II Scale and Ranson Scale in Severe Acute Pancreatitis in the Emergency Department Evaluation Between II Scale and Ranson Scale in Severe Acute Pancreatitis

Apache Abstract Introduction: Acute pancreatitis is a common disease, characterized by inflammation and destruction of the pancreas. There are multiple scales for its assessment within which are the Ranson prognostic scale and the Apache II scale. Our objective is to know the prognostic evaluation between Apache II and Ranson scales in severe acute pancreatitis in the emergency department. Objective: To know the prognostic evaluation between Apache II and Ranson scale in severe acute pancreatitis, in the emergency department. Material and methods: A retrospective, cross-sectional, comparative and observational study was carried out in patients older than 18 years with acute pancreatitis in a period of 3 months, the Apache II and Ranson scale were applied; They were classified as: mild and severe. Non-probabilistic samples, for convenience. The severity predictors were compared using the confidence intervals, area under the ROC curve (Receiver Operating Characteristics), significance level of p: <0.05%. Results: Mild pancreatitis was higher, Ranson being 39% mild, 21% grave, and Apache II scale, 57% mild, and 43% grave. The APACHE II scale has a higher sensitivity (65.52) compared to the RANSON scale (43.10). In our environment, it obtained a fairly acceptable value, compared to the Ranson scale. The APACHE II scale presented a higher sensitivity with respect to the RANSON scale.

GMR.000622. 5 (5).2021 at 48hrs [6,11,12]. On the other hand, the Apache scale II can be calculated at any time during the BP, even during the first hours, where a count greater than or equal to 8 points indicates severe pancreatitis, it has the advantage of being the most accurate predictor with acceptable rates of sensitivity and specificity [3,10,13,14]. Both multifactorial clinical scoring systems have been useful in assessing the severity of acute pancreatitis, although the disadvantages of these scoring scales are that they are not designed to predict possible complications of the disease [6]. Therefore, all patients admitted to the emergency department with a diagnosis of acute pancreatitis will have to be evaluated with the Apache II and Ranson prognostic scales with the intention of determining those who potentially develop a severe acute pancreatitis picture.
In Mexico the evaluations of the prognostic scales or parameters for acute pancreatitis have been little studied, which is why it is of vital importance to evaluate and review them, fifteen therefore, the objective of this present is to know the prognostic evaluation between Apache II and Ranson scale in severe acute pancreatitis, in the emergency department

Material and Methods
Retrospective, cross-sectional, comparative and observational design, in 60 patients older than 18 years of age, with a clinical

Results
It was possible to determine that there is a higher prevalence of this pathology in female patients with 60%, (n:36), Figure 1, having a mean age of 51.58%, Table 1. The pancreatitis distribution was higher in pancreatitis mild, obtaining by means of the Ranson scale 39% of the pancreatitis were mild and 21% severe and with the measurement made with the Apache II scale 57% were mild and 43% were classified as severe Table 2. Each prognostic score has its own sensitivity, Specificity and feasibility, in the present study it was found that the Apache II Scale presents greater sensitivity (65.52) compared to the RANSON scale (43.10), with a low specificity of 26.0, and a PPV of 97% Table 3a&3b. The comparison of scales is specified in Figure 2. The area of the ROC curve for the Apache scale was 0.793, Figure 3.

Discussion
The immense knowledge harbored over the years since the   Cabinet tools [14].

Conclusion
Acute pancreatitis is more prevalent in female patients. It was found that based on the results obtained, the distribution of pancreatitis was greater in mild pancreatitis. Each prognostic Score has its own sensitivity, specificity and feasibility, in the present study it was found that the APACHE II Scale presents greater sensitivity (65.52) compared to the RANSON scale (43.10), low specificity of (26.0), however with a PPV of 97%. Therefore, it is translated that this scale, although in contrast to the international literature, places it with a low positive predictive value, in our environment it obtained a fairly acceptable value, placing it as the best scale compared to Ranson. The Ranson scale, even with its limitations because we cannot determine it before 48hours, can continue to be used in our hospital as a prognostic factor of severity, taking into account the low specificity (50.00), with a sensitivity of (43.10), and a high NPV of (76.36), PPV of (36.15) so the use of said score is left to medical consideration.