Background: Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step in improving outcome. Methods: Using Classification and Regression Tree (CART) analysis, a clinical scoring system was developed for prediction of in-hospital mortality in AP. The scoring system was derived on data collected from 17 992 cases of AP from 212 hospitals in 2000-2001. The new scoring system was validated on data collected from 18 256 AP cases from 177 hospitals in 2004-2005. The accuracy of the scoring system for prediction of mortality was measured by the area under the receiver operating characteristic curve (AUC). The performance of the new scoring system was further validated by comparing its predictive accuracy with that of Acute Physiology and Chronic Health Examination (APACHE) II. Results: CART analysis identified five variables for prediction of in-hospital mortality. One point is assigned for the presence of each of the following during the first 24 h: blood urea nitrogen (BUN) >25 mg/dl; impaired mental status; systemic inflammatory response syndrome (SIRS); age >60 years; or the presence of a pleural effusion (BISAP). Mortality ranged from >20% in the highest risk group to <1% in the lowest risk group. In the validation cohort, the BISAP AUC was 0.82 (95% Cl 0.79 to 0.84) versus APACHE II AUC of 0.83 (95% Cl 0.80 to 0.85). Conclusions: A new mortality-based prognostic scoring system for use in AP has been derived and validated. The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality.

The early prediction of mortality in acute pancreatitis : a large population-based study. Commentary

Background: Acute severe pancreatitis is life threatening condition with organ failure, pancreatic necrosis, infections, and death. Multiple factor scoring systems are used for triage decision to manage of acute pancreatitis according to severity. Our purpose of this study was to assess the efficiency of the bedside index of severity in acute pancreatitis (BISAP) score and computed tomography severity index (CTSI) scoring system to predict severity of acute pancreatitis.Methods: This hospital based observational, prospective study was conducted from 01 March 2019 to May 2020. An inclusion criterion was patients admitted with diagnosis of acute pancreatitis. Comparative analysis was done for BISAP and CTSI in terms of severity and mortality.Results: The mean age was 44.7±16.2 years and male to female ratio was 1.9:1. BISAP score had 91.7% sensitivity and 51.4% specificity in predicting severity of acute pancreatitis with 38.6% positive predictive value (PPV) and 94.9% negative predictive value (NPV). CTSI score had 95.8% sensitivity and 44.4% specificity in predicting severity of acute pancreatitis with 36.5% PPV and 96.9% NPV. The area under curve (AUC) for BISAP and CTSI was 0.853 (95% CI: 0.769–0.937) and 0.901 (95% CI: 0.831– 0.97) respectively.Conclusions: We conclude that BISAP score is better predictor of severity and mortality in acute pancreatitis and can safely be utilized to predict severity of acute pancreatitis in situations where use of CT is limited due to cost factor or availability, especially in rural areas. BISAP score is a scoring system that can be easily calculated with available clinical data even in small hospital setups.

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Comparative evaluation of BISAP score and computed tomography severity index as a predictor for severity of acute pancreatitis

BACKGROUND Acute pancreatitis (AP) is a dormant deadly illness. The range of seriousness of the ailment goes from mellow self-restricting disease to an exceptionally lethal severe necrotizing pancreatitis. The disease has such a variable course that it may manifest as a simple pain in the abdomen to severe haemorrhagic pancreatitis with septicaemic shock, multi-organ dysfunction syndrome and ultimately leading to death. A cost-effective better prognosticative index is needed for the assessment of the severity of AP. Here in this study, we wanted to assess the role of BISAP scoring systems and CRP for analysis and comparing their values to determine the severity of AP and the prognosis of the disease. METHODS A prospective observational study was done on 83 patients diagnosed with AP after fulfilment of inclusion criteria. Patients were subjected to severity index, bedside index for severity in acute pancreatitis (BISAP) score and CRP calculation and statistical analysis was done with SPSS software. RESULTS In our study, AP was more prevalent in males 87.95 % than females 12.05 %. AP was found to be more common in cases ≤ 40 years of age, however, the mean age of presentation was 38.14 ± 12.59 years. We calculated the sensitivity and specificity of the BISAP score and C-reactive protein (CRP) by co-relating it with CT severity index as gold standard according to which the sensitivity was found to be 64 % and specificity was found to be 85 % for BISAP. The sensitivity and specificity of CRP was 64 % and 85 % respectively. CONCLUSIONS BISAP is an easy way to anticipate the severity of AP within 24 hours. It also helps to prognosticate AP. CRP can also be used to aid BISAP in the assessment of severe acute pancreatitis (SAP). KEY WORDS Acute Pancreatitis, BISAP, CRP.

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Assessment of BISAP Scoring System and C-Reactive Protein Analysis in Predicting Severity of Acute Pancreatitis

Early diagnosis of severe acute pancreatitis (SAP) is important for the successful management of patients. Most scoring systems are complex or involve multiple parameters, which makes it difficult to ascertain the severity of acute pancreatitis at an early stage. Our study aims to evaluate the bedside index for severity in acute pancreatitis (BISAP) in predicting the severity of pancreatitis and mortality in a rural population, where financial constraints pose a major problem during treatment. We studied 55 patients of acute pancreatitis who presented to our institution between October 2014 and August 2016. The BISAP score was calculated within 24 h of admission. During the hospital stay, the CT severity index (CTSI) was calculated, and patients closely monitored to detect presence of organ failure or mortality. The accuracy of the BISAP and CTSI scores in predicting severity and mortality was determined by plotting receiver operating characteristic (ROC) curves, and calculating the area under curve (AUC). Sixteen (29%) patients developed persistent organ failure and were classified as severe acute pancreatitis (SAP), and four (7%) died. No patient with a BISAP score of 0 or 1 developed severe pancreatitis. The area under curve (AUC) for BISAP score in predicting severity and mortality was 0.902 and 0.958, respectively, better than that of CTSI. BISAP scores of 0 or 1 have a very high negative predictive value, and hence accurate for predicting mild disease. These patients can safely avoid a CT scan and the costs associated with it.

Comparative Evaluation of the BISAP Score with CT Severity Index in Predicting the Severity of Acute Pancreatitis

Introduction: Clear cell variant of follicular thyroid carcinoma with synchronous bony metastasis and a normal thyroid stimulating hormone level, is an extremely rare condition. Case Report: A 55-year-old male was presented to us with a painful swelling in the right arm. The biopsy showed clear cell adenocarcinoma, raising concerns for a metastatic renal cell carcinoma. Computed tomography scan of abdomen failed to show any renal lesions. A detailed physical examination revealed a small nodule of the right thyroid lobe. Fine needle aspiration cytology (FNAC) of the nodule was reported as follicular neoplasm. A right hemithyroidectomy and the subsequent completion thyroidectomy showed clear cell type of follicular thyroid carcinoma. Immunohistochemistry for thyroglobulin (Tg) further confirmed the diagnosis. Conclusion: Clear cell variant of follicular thyroid carcinoma is a very rare condition, hence a high index of suspicion is essential for diagnosis. The importance of performing a detailed physical examination cannot be more emphasized as small thyroid lesion like in this case can be easily missed, leading to a delay in diagnosis. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 8 No. 3, March 2017. ISSN – [0976-3198] Int J Case Rep Images 2017;8(3):196–200. www.ijcasereportsandimages.com Vaidya et al. 196 CASE REPORT PEER REVIEWED | OPEN ACCESS Role of immunohistochemistry in metastatic clear cell variant of follicular thyroid carcinoma: A case report Yash Pradeep Vaidya, Rajan Vaithianathan, Ramanathan Manickam, Dhananjay Kotasthane

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Ramanathan Manickam

Papers

Comparative Evaluation of the BISAP Score with CT Severity Index in Predicting the Severity of Acute Pancreatitis

Role of immunohistochemistry in metastatic clear cell variant of follicular thyroid carcinoma: A case report