Prognostic Value of qSOFA and ERAP Scores for Outcome Prediction in Acute Pancreatitis: A Systematic Review and Exploratory Meta-analysis

Background and aims.Early identification of patients with acute pancreatitis (AP) who will follow a severe course is a central, unmet challenge of emergency care. The quick Sequential Organ Failure Assessment (qSOFA) score is an attractively simple bedside tool, and the Emergency Room Assessment of Acute Pancreatitis (ERAP) score is a newer four-item refinement that adds blood urea nitrogen and C-reactive protein to two qSOFA criteria. We systematically reviewed and, where data permitted, quantitatively pooled the evidence on the prognostic accuracy of qSOFA and ERAP for severity, organ failure, intensive-care admission and mortality in AP.Methods.We searched PubMed/MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library through May 2026 for cohort and diagnostic-accuracy studies reporting qSOFA and/or ERAP at presentation in adults with AP. Two reviewers screened records, extracted data and assessed risk of bias with QUADAS-2. Discrimination was summarised by AUC; for ERAP, AUCs for severe AP and in-hospital mortality were pooled using a DerSimonian-Laird random-effects model. qSOFA evidence was synthesised structurally because outcomes and thresholds were too heterogeneous for valid pooling.Results.Five cohorts (n = 1,243 patients) met inclusion criteria. qSOFA was consistently specific but markedly insensitive: at a threshold of at least 1 point it discriminated intensive-care admission and multi-organ dysfunction with AUCs of 0.73 and 0.80, but at the guideline threshold of at least 2 points sensitivity for clinically significant disease fell to 4%. ERAP outperformed qSOFA across every reported endpoint. The pooled ERAP AUC was 0.82 (95% CI 0.71-0.93; I-squared = 89%) for severe AP and 0.85 (95% CI 0.81-0.90; I-squared = 0%) for in-hospital mortality, with a consistent optimal threshold of at least 2 points and negative predictive values of 95-100%. In three head-to-head cohorts ERAP equalled or exceeded the Bedside Index for Severity in Acute Pancreatitis (BISAP).Conclusions.qSOFA alone is too insensitive to be used as a stand-alone rule-out tool in AP, although a positive score should prompt escalation. The four-item ERAP score shows promising and reproducible discrimination for organ failure and mortality and rivals BISAP while requiring fewer variables, but the total evidence base remains small and single-centre. Adequately powered, multicentre, prospectively registered validation with standardised thresholds and outcomes is required before ERAP can be recommended for routine triage.