Comparative Analysis of Scoring Systems in Acute Pancreatitis: Evaluating PASS and CSSS For Clinical Severity and Outcome Prediction

Abstract

Objective: Acute pancreatitis (AP) presents with a wide clinical spectrum, ranging from mild self-limited disease to life-threatening organ failure. Accurate early risk stratification is essential for guiding intensive monitoring and resource utilisation. Existing prognostic tools differ in accuracy, complexity and bedside practicality. This study compared the Glasgow (Imrie) score, the Pancreatitis Activity Scoring System (PASS) and the Chinese Simple Scoring System (CSSS) for early severity stratification and prediction of in-hospital mortality. Methods: A hospital-based retrospective observational study was conducted in the Department of General Surgery, Government Medical College, Jammu, over a twelve-month period from February 2025 to January 2026. Of 187 patients screened, 156 fulfilled the Revised Atlanta diagnostic criteria and 100 eligible patients formed the final cohort. Primary endpoints were development of severe acute pancreatitis (SAP), classified according to the Revised Atlanta Classification as persistent organ failure (>48 hours), and in-hospital mortality. Receiver operating characteristic (ROC) analysis was used to derive the area under the curve (AUC), optimal cut-off values, sensitivity, specificity, positive predictive value and negative predictive value for each score. Results: Of the 100 patients included in the final analysis, 54 (54%) were classified as mild acute pancreatitis, 11 (11%) as moderately severe, and 35 (35%) as severe acute pancreatitis. Eight patients (8%) died during the index admission. The Glasgow score showed the strongest discrimination for early severity prediction (AUC 0.841), while PASS assessed on day 7 was superior for mortality prediction (AUC 0.832). CSSS occupied an intermediate position for severity (AUC 0.798) and was the most specific predictor of mortality (84.8%). All three systems achieved negative predictive values above 95% for in-hospital mortality. Conclusion: The Glasgow score, calculated from routinely available admission parameters, provided the most accurate early identification of severe acute pancreatitis, and day-7 PASS assessment provided the most accurate prediction of in-hospital mortality. Both scores are readily applicable at the bedside and offer complementary prognostic information for risk assessment in a tertiary surgical setting.