The incidence and prevalence of acute pancreatitis (AP) is increasing over time. The diagnosis of acute pancreatitis is established by revised Atlanta criteria (2012). Multiple criteria and scoring systems have been used for assessment of severity of AP. Majority of acute pancreatitis cases (80%) are mild, the challenge remains in early diagnosis, severity assessment and treatment of severe AP and its complications. Assessment of severity of AP is important part of management because line of treatment depends on aetiology and severity of acute pancreatitis. In this article a comprehensive review of recent advances in diagnosis and severity assessment of acute pancreatitis has been described.

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Recent Advances in Diagnosis and Severity Assessment of Acute Pancreatitis

Objective: To determine diagnostic accuracy of BISAP in comparison to Ranson scores in predicting mortalities and severities in patients with acute pancreatitis coming to the emergency department.
Methods: Cross-sectional study conducted in Department of Emergency Medicine, Aga Khan University Hospital, Stadium road Karachi, Pakistan. 136 patients were selected via non-probability consecutive sampling technique, those who fulfilled the criteria of inclusion. BISAP score was applied in the emergency department (ED) & the patients were followed in ward/intensive care unit where Ranson scores were calculated in the following 48 hours. Both the scores were calculated and compared for the prediction of severity and mortality for each patient. All the obtained data was recorded in Performa.
Results: In this study 136 patients, who fulfill the inclusion criteria were selected. On the basis of BISAP and Ranson score; mild acute pancreatitis to moderate acute pancreatitis (MAP to ModAP) was diagnosed in 123 (90.4%) and 119 (87.5) patients and severe AP (SAP) in 13 (9.6%) and 17 (12.5%) patients respectively. Specificity (Sp) 94.62% vs 91.54%, Sensitivity (Sn) 100.0% vs 100.0%, negative predictive value (NPV) 100.0% vs 100.0%, positive predictive value (PPV) 46.15% vs 35.29% and diagnostic accuracy (DA) 94.85% vs 91.91% of BISAP vs Ranson scores respectively.
Conclusion: It was concluded from the study that BISAP and Ranson score are very reliable tool for identification of acute pancreatitis patients at higher risk of severity and mortality. BISAP and Ranson score has same sensitivity but BISAP score has higher specificity than Ranson score.
Continuous...

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Bedside index (BISAP) v/s Ranson scores in predicting mortality and severity in patients with acute pancreatitis.

Acute pancreatitis is a common and recurrent disorder, where inflammation of the pancreas with inconstant connection of other surrounding tissues or other organ systems. This condition is characterized by long-term pain in the abdomen area, frequent exacerbations of the disease, and insufficiency of the exocrine and/or endocrine. Among the individuals with pancreatitis, identification of patients who are at risk of severe disease and mortality is a crucial step for the purpose of effective management and prevention of mortality. Numerous scoring systems are present to help assess disease severity and

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Scoring Systems to Predict the Severity of Acute Pancreatitis-A Review

Acute pancreatitis is a common disease in patients presenting to the emergency room in any hospital. The most common causes are alcohol ingestion and gallstone disease. Diagnosis is usually based on clinical findings and elevated serum amylase and lipase levels. Imaging is often not necessary but may be used to confirm the diagnosis or rule out any other pathology or to evaluate for any complications. The majority of patients will have a mild, self-limiting disease but others may develop a severe fulminant course with organ failure. These patients are at high risk of developing complications, morbidity or mortality. Treatment of acute pancreatitis includes supportive treatment with antibiotics, fluids, analgesics and early enteral feeding. Several scores have been developed to predict the course of pancreatitis and help make informed decisions, monitoring and timely intervention. The majority of them are complicated, require extensive and expensive interventions or require time. Harmless acute pancreatitis score (HAPS) is one such score that is easy to calculate and is done at the time of admission, bedside index of severity in acute pancreatitis (BISAP) is another one requiring more parameters. The parameters used to calculate it are easily available and can be done at a majority of healthcare facilities in developing countries. HAPS thus seems to be a good option in aiding doctors in assessing acute pancreatitis. It may be considered as a standard scoring for acute pancreatitis for early and effective management. We have tried to study and compare the superiority of HAPS over BISAP in predicting prognosis in acute pancreatitis.

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Comparative Evaluation of Harmless Acute Pancreatitis Score (HAPS) and Bedside Index of Severity in Acute Pancreatitis (BISAP) Scoring System in the Stratification of Prognosis in Acute Pancreatitis

Abstract Background/Aim Acute pancreatitis is encountered in both medical and surgical specialty. Assessment of severity and grading is done using radiological investigations mostly like ultrasonography or CECT. We present a study to assess the severity of Acute Pancreatitis based on Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system. Material & Methods The study was conducted on 50 patients presenting with acute pancreatitis who were included as per inclusion criteria and a detailed history, clinical examination and blood investigation performed. Data like serum amylase, serum lipase, serum calcium, blood urea nitrogen (BUN), pleural effusion and systemic inflammatory response syndrome (SIRS) was collected from the patients. Based on data collected in 24 hours of hospitalization, BISAP score was calculated. Results Results showed that no significant temperature rise, pancreatic necrosis, SIRS or impaired mental status in patients with BISAP severity of <=3. However, patients having BISAP score >3, factors like BUN, age, pleural effusion, and organ failure show significant correlation. Also on comparative analysis of patients showed that the hospital stay, respiratory rate, pulse and laboratory markers (blood urea, serum creatinine, serum amylase, serum lipase) were significantly higher in patients with BISAP score ≥3. Conclusion BISAP score is an easy, quick and bedside method to assess the severity of acute pancreatitis and predict its mortality. It is easy bedside procedure that can be done in every setup.

Evaluation of acute pancreatitis based on BISAP scoring system: A cohort study of 50 cases

Background: The bedside index for severity in acute pancreatitis (BISAP), a newer prognostic scoring system, has been proposed as a simple and clinically oriented severity scoring system for early identification of patients with acute pancreatitis. This study evaluates the efficacy of BISAP score to predict the severity of organ failure in patients of acute pancretitis and its correlation with Marshall score. Methods: The clinical, laboratory and radiological data for all patients admitted with a diagnosis of acute pancreatitis conducted at tertiary hospital of Armed Forces over a two-year period, was prospectively collected for this study. BISAP score was calculated within 24hrs of presentation. Markers of severity were the development of organ failure and presence of pancreatic necrosis. Outcome at 28 days (viz. recovery, organ failure and mortality) was studied for each patient. BISAP score computed at 24h was correlated with the above and its efficacy to predict the severity of organ failure in Acute Pancreatitis, was assessed. Results: Out of 50 patients in the study group, 41 were male and 9 were female with the mean (±SD) age 43.74±16.85 years. Majority of the study population had alcohol (56%) as the etiology followed by gall stones (28%). Outcome assessed at 28 days revealed recovery of 54%, complication of 36% and mortality of 10% of study population. BISAP score computed within 24 hours of admission of 2 or more significantly predicted the severity and complication with P value <0.001. Statistically significant trends of increasing severity and organ failure (P<0.001) with increasing BISAP was observed. Conclusions: BISAP score is a reliable means of predicting the severity and organ failure and stratifying patients with Acute Pancreatitis within 24 hours of admission. The statistically significant incidence of increasing severity and mortality with increasing BISAP score will help us to risk stratify the patients within 24 hours of admission and help improve clinical care and facilitate necessary interventions as early as possible.

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Rahul Jain

Papers

Prospective evaluation of the BISAP score and its correlation with Marshall score in predicting severity of organ failure in acute pancreatitis