The ROC curve analysis showed that the Ranson scoring system was inferior to the other considered scoring systems in predicting mortality in elderly AP patients. The BISAP and Glasgow scores were similar and superior to the Ranson score in predicting disease severity. The BISAP, Glasgow, and APACHE II scores were superior to the Ranson score in predicting organ failure, complications, ICU admission, and prolonged hospital stay.
With the increasing world population and increased life expectancy, AP has become more common in the elderly population . The few relevant studies available in the literature have shown that elderly patients with AP usually present with a more severe clinical picture with higher rates of permanent organ failure, pancreatic necrosis, and mortality [22–26]. In a recent single-center study  and a study on the predictors of severity of AP in the elderly population , progression to severe disease was significantly more common in elderly patients. We also found similar results regarding progression to severe AP.
The Ranson score is the first scoring system used to evaluate biliary and non-biliary AP and it requires a timeframe of 48 hours for a complete score . Generally, a Ranson score of 3 or higher is required to diagnose severe AP. One study compared the Ranson, BISAP, APACHE II, and CTSI scores and found that the Ranson score’s AUC values for predicting disease severity, pancreatic necrosis, and mortality were superior to those of the BISAP and APACHE II systems and that all patients who died had a Ranson score of ≥ 3 . Another study similarly compared Ranson, BISAP, Glasgow, and APACHE II scores and demonstrated that the Ranson score’s AUC values for predicting disease severity and mortality were lower compared to BISAP and Glasgow scores in elderly patients. However, in younger patients, the Ranson score was superior to the other scoring systems in predicting disease severity and was superior to BISAP and APACHE II in predicting mortality . In the first of these studies, conducted by Ranson and Pasternack, biliary pancreatitis accounted for 36% of all cases of AP, whereas in the second study, biliary pancreatitis accounted for 75% of all cases among elderly patients and 51.5% of cases among younger patients with AP. Ranson and his colleagues reported the rate of biliary pancreatitis to be 14% in 1974 and 17% in 1977 [15, 31]. These findings suggest that the Ranson scoring system is less effective in elderly patients with biliary pancreatitis. We also found that the Ranson scoring system was less clinically useful in elderly patients with biliary pancreatitis.
The Glasgow scoring system employs parameters similar to those of the Ranson score as well as objective clinical evaluations and similarly requires 48 hours of follow-up . The APACHE II score was developed mainly for the assessment of ICU patients and has been used for the assessment of AP since 1989 [17, 18]. The BISAP is a more recent scoring system aimed at early detection of patients at risk for in-hospital mortality [18, 32], and recent prospective clinical studies have shown it to be reliable in the evaluation of patients with AP . A recent study by Li et al. revealed that the BISAP score is valid for predicting disease severity, pancreatic necrosis, and mortality in elderly patients, whereas the APACHE II score is more suitable for younger patients . In our study, we compared the BISAP, Glasgow, and APACHE II scores and found that BISAP and APACHE II were significantly different only in the prediction of complications, and the 3 scoring systems were not significantly superior to one another in terms of the remaining parameters. In reference to these results, besides etiology, we think that the relatively poor efficacy of the Ranson score in elderly patients may be attributed to the high prevalence of comorbidities in this population. The follow-up periods required by the scoring systems are a disadvantage in estimating severity and mortality in elderly patients with comorbidities, and parameters that are not related to AP interfere with the assessment of this disease.
The major limitation of our study is its retrospective design, which limited our access to vital findings and detailed anamnesis.