• Arif A Khan, Dilip Parekh, Young Cho, Richard Ruiz, Robert R Selby, Nicolas Jabbour, Yuri S Genyk, and Rodrigo Mateo.
• Department of Surgery, The University of Southern California, 1510 San Pablo St, Suite 430, Los Angeles, CA 90033, USA.
• Arch Surg Chicago. 2002 Oct 1;137(10):1136-40.

HypothesisThe 48-hour APACHE (Acute Physiology and Chronic Health Evaluation) II score is a better predictor of pancreatic necrosis, organ failure, and mortality in patients with severe acute pancreatitis than the score at hospital admission.DesignA retrospective analysis of 125 patients with acute pancreatitis.SettingA tertiary public teaching hospital.PatientsPatients with severe acute pancreatitis as defined by 3 or more Ranson criteria or a hospital stay of longer than 6 days.Main Outcome MeasuresPancreatic necrosis, organ failure, and mortality.ResultsA significant association was found between the 48-hour score and the presence of pancreatic necrosis (P<.001), organ failure (P =.001), and death (P<.001). By contrast, the APACHE II score at admission was significantly associated only with the presence of organ failure (P =.007). Deteriorating APACHE II scores over 48 hours were significantly associated with a fatal outcome (P =.03). The combined APACHE II score (defined as the sum of the admission and 48-hour scores) was significantly higher among nonsurvivors than survivors (P<.001), and was strongly associated with the presence of pancreatic necrosis (P =.001) and organ failure (P<.001). The 48-hour and combined scores accurately predicted outcome in 93% of the patients compared with 75% by the admission score.ConclusionsThe 48-hour APACHE II score has improved predictive value compared with the admission score for identifying patients with severe acute pancreatitis who have a poor outcome. A deteriorating APACHE II score at 48 hours after admission may identify patients at risk for an adverse outcome.

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