Predicting morbidity and mortality in acute pancreatitis in an Indian population: a comparative study of the BISAP score, Ranson’s score and CT severity index
TL;DR: The BISAP score represents a simple way of identifying, within 24 hours of presentation, patients at greater risk of dying and the development of intermediate markers of severity, in a tertiary care centre in east central India.
Abstract: Objective: Our aim was to prospectively evaluate the accuracy of the bedside index for severity in acute pancreatitis (BISAP) score in predicting mortality, as well as intermediate markers of severity, in a tertiary care centre in east central India, which caters mostly for an economically underprivileged population. Methods: A total of 119 consecutive cases with acute pancreatitis were admitted to our institution between November 2012 and October 2014. BISAP scores were calculated for all cases, within 24 hours of presentation. Ranson’s score and computed tomography severity index (CTSI) were also established. The respective abilities of the three scoring systems to predict mortality was evaluated using trend and discrimination analysis. The optimal cut-off score for mortality from the receiver operating characteristics (ROC) curve was used to evaluate the development of persistent organ failure and pancreatic necrosis (PNec). Results: Of the 119 cases, 42 (35.2%) developed organ failure and were classified as severe acute pancreatitis (SAP), 47 (39.5%) developed PNec, and 12 (10.1%) died. The area under the curve (AUC) results for BISAP score in predicting SAP, PNec, and mortality were 0.962, 0.934 and 0.846, respectively. Ranson’s score showed a slightly lower accuracy for predicting SAP (AUC 0.956) and mortality (AUC 0.841). CTSI was the most accurate in predicting PNec, with an AUC of 0.958. The sensitivity and specificity of BISAP score, with a cut-off of � 3 in predicting mortality, were 100% and 69.2%, respectively. Conclusions: The BISAP score represents a simple way of identifying, within 24 hours of presentation, patients at greater risk of dying and the development of intermediate markers of severity. This risk stratification method can be utilized to improve clinical care and facilitate enrolment in clinical trials.
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TL;DR: The BISAP score was similar to APACHE II and modified CTSI in terms of accuracy, sensitivity, specificity, and NPV, and should be used for early triage and referral to a high dependency unit.
Abstract: Aims of this study Severe acute pancreatitis has been defined recently based on the persistence of organ failure at 48 hours of admission. The bedside index for severity in acute pancreatitis (BISAP) score, a simplified scoring system to predict severity of acute pancreatitis, is proposed to be useful in early risk stratification of acute pancreatitis. Our aim was to prospectively compare BISAP score with the already established acute physiology and chronic health evaluation II (APACHE II) and modified computed tomography severity index (CTSI) scores in predicting the severity of acute pancreatitis. Materials and methods A total of 87 consecutive cases presenting with the first attack of acute pancreatitis were included in the study. Acute physiology and chronic health evaluation II and BISAP scores were calculated from the worst parameters in the first 24 hours, and modified CTSI was reported at 48 hours of admission. Receiver-operating characteristic (ROC) curves were plotted, and predictive accuracy of each score was calculated from the area under the curve. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each score. Results A total of 20 patients (23%) had severe acute pancreatitis with a total of 11 mortalities (12.64%), 10 of them in the severe acute pancreatitis group. Acute physiology and chronic health evaluation II, modified CTSI, and BISAP score all correlated well with each other. Modified CTSI and BISAP score also correlated with duration of hospital stay. Areas under the curve for APACHE II (≥8), modified CTSI (≥8), and BISAP score (≥2) were 0.826, 0.806, and 0.811, respectively, suggesting similar predictive accuracy. Conclusion The BISAP score was similar to APACHE II and modified CTSI in terms of accuracy, sensitivity, specificity, and NPV. It is much easier to calculate and a useful risk stratification tool. It should be used for early triage and referral to a high dependency unit. How to cite this article Chatterjee R, Parab N, Sajjan B, Nagar VS. Comparison of Acute Physiology and Chronic Health Evaluation II, Modified Computed Tomography Severity Index, and Bedside Index for Severity in Acute Pancreatitis Score in Predicting the Severity of Acute Pancreatitis. Indian J Crit Care Med 2020;24(2):99-103.
10 citations
TL;DR: Extra-pancreatic complications occur frequently in ICU patients with AP and impact LOS and mortality, and patients with non-infectious extra-p Pancreatic Complications have a higher mortality rate.
Abstract: Background and aims Patients in the intensive care unit (ICU) with acute pancreatitis (AP) are at risk for extra-pancreatic complications given their severe illness and prolonged length of stay. We sought to determine the rate of extra-pancreatic complications and its effect on length of stay (LOS) and mortality in ICU patients with AP. Methods We performed a retrospective cohort study of ICU patients admitted to a tertiary-care center with a diagnosis of AP. A total of 287 ICU patients had a discharge diagnosis of AP, of which 163 met inclusion criteria. We calculated incidence rates of extra-pancreatic complications and performed a univariate and multi-variable analysis to determine predictors of LOS and mortality. Results There were a total of 158 extra-pancreatic complications (0.97 extra-pancreatic complications per patient). Ninety-five patients had at least one extra-pancreatic complication, whereas 68 patients had no extra-pancreatic complications. Patients with extra-pancreatic complications had a significantly longer LOS (14.7 vs 8.8 days, p < 0.01) when controlling for local pancreatic complications. Patients with non-infectious extra-pancreatic complications had a higher rate of mortality (24.0% vs 16.2%, p = 0.04). Patients requiring dialysis was an independent predictor for LOS and mortality (incidence risk ratio [IRR] 1.73, 95% confidence interval [CI]: 1.263-2.378 and IRR 1.50, 95% CI 1.623-6.843, p < 0.01) on multi-variable analysis. Coronary events were also a predictor for mortality (p = 0.05). Other extra-pancreatic complications were not significant. Conclusions Extra-pancreatic complications occur frequently in ICU patients with AP and impact LOS. Patients with non-infectious extra-pancreatic complications have a higher mortality rate. After controlling for local pancreatic complications, patients requiring dialysis remained an independent predictor for LOS and mortality.
10 citations
TL;DR: An overview of the available scoring systems and biochemical markers for predicting severe acute pancreatitis, with a focus on their characteristics and limitations is provided in this article , where the authors also provide an overview of their limitations.
Abstract: Acute pancreatitis has a diverse etiology and natural history, and some patients have severe complications with a high risk of mortality. The prediction of the severity of acute pancreatitis should be achieved by a careful ongoing clinical assessment coupled with the use of a multiple-factor scoring system and imaging studies. Over the past 40 years, various scoring systems have been suggested to predict the severity of acute pancreatitis. However, there is no definite and ideal scoring system with a high sensitivity and specificity. The interest in new biological markers and predictive models for identifying severe acute pancreatitis testifies to the continued clinical importance of early severity prediction. Although contrast-enhanced computed tomography (CT) is considered the gold standard for diagnosing pancreatic necrosis, early scanning for the prediction of severity is limited because the full extent of pancreatic necrosis may not develop within the first 48 h of presentation. This article provides an overview of the available scoring systems and biochemical markers for predicting severe acute pancreatitis, with a focus on their characteristics and limitations.
7 citations
Journal Article•
TL;DR: The BISAP score represents a simple way to accurately identify patients at risk of developing severe acutepancreatitis within 24 hours of presentation in the authors' setup and can be utilized to improve clinical care.
Abstract: Objective: To determine the frequency of mortality of patients with Acute Pancreatitis having bedside index for severityin acute pancreatitis (BISAP).Material and Methods: This was a Cross sectional descriptive study, conducted at Department of Surgery of KhyberTeaching Hospital, Peshawar-Pakistan, from January 2014 to June 2016 on patients after diagnosing the disease severityof the acute pancreatitis and expected mortality of patients were calculated on bedside index for severity in acutepancreatitis (BISAP) >3 and analyzed using Statistical Package for Social Sciences 20.Results: In this study, 65 patients presenting with acute pancreatitis were observed, in which male to female ratio was1.24:1. The study included age ranged from 16 up to 75 years. Average age was 52.85 years + 12.99 SD. Mortalitywas observed in 51(78.46%) patients having acute pancreatitis by using BISAP score.Conclusion: The BISAP score represents a simple way to accurately identify patients at risk of developing severe acutepancreatitis within 24 hours of presentation in our setup. Its components are clinically relevant and easy to obtain. Thisrisk stratification capability can be utilized to improve clinical care
4 citations
TL;DR: In this article , a predictive model for in-hospital mortality in acute pancreatitis patients was developed using measured sentiment scores in nursing notes, and the predictive value of nursing notes for AP prognosis is unclear.
Abstract: Background: Accurate and prompt clinical assessment of the severity and prognosis of patients with acute pancreatitis (AP) is critical, particularly during hospitalization. Natural language processing algorithms gain an opportunity from the growing number of free-text notes in electronic health records to mine this unstructured data, e.g., nursing notes, to detect and predict adverse outcomes. However, the predictive value of nursing notes for AP prognosis is unclear. In this study, a predictive model for in-hospital mortality in AP was developed using measured sentiment scores in nursing notes.
3 citations
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TL;DR: A CT severity index, based on a combination of peripancreatic inflammation, phlegmon, and degree of pancreatic necrosis as seen at initial CT study, was developed and showed clear trends in patients who initially had or developed more than 30% necrosis.
Abstract: The presence and degree of pancreatic necrosis (30%, 50%, or greater than 50%) was evaluated by means of bolus injection of contrast material and dynamic sequential computed tomography (CT) in 88 patients with acute pancreatitis at initial and follow-up examinations. Pancreatic necrosis was defined as lack of enhancement of all or a portion of the gland. Length of hospitalization, morbidity, and mortality in patients with early or late necrosis (22 patients) were evaluated and compared with the same criteria in the rest of the group. Patients with necrosis had a 23% mortality and an 82% complication rate; patients without necrosis had 0% mortality and 6% morbidity. When only the initial assessment was considered, patients with peripancreatic phlegmons and necrosis had 80% morbidity, compared with 36% morbidity in those with phlegmons and no necrosis. Serious complications occurred in patients who initially had or developed more than 30% necrosis. A CT severity index, based on a combination of peripancreatic inflammation, phlegmon, and degree of pancreatic necrosis as seen at initial CT study, was developed. Patients with a high CT severity index had 92% morbidity and 17% mortality; patients with a low CT severity index had 2% morbidity, and none died.
1,463 citations
TL;DR: The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality in acute pancreatitis.
Abstract: 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 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.
601 citations
"Predicting morbidity and mortality ..." refers background or methods in this paper
...proposed a new prognostic scoring system for the early determination of the severity of acute pancreatitis, which they named the ‘bedside index of severity in acute pancreatitis’ (BISAP) [1, 2]....
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...to be an accurate tool for risk stratification of acute pancreatitis in western populations [1, 3]....
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TL;DR: It is confirmed that the BISAP score is an accurate means for risk stratification in patients with AP and simple scoring systems may have reached their maximal utility and novel models are needed to further improve predictive accuracy.
470 citations
TL;DR: The BISAP score represents a simple way to identify patients at risk of increased mortality and the development of intermediate markers of severity within 24 h of presentation and can be utilized to improve clinical care and facilitate enrollment in clinical trials.
239 citations
"Predicting morbidity and mortality ..." refers background in this paper
...proposed a new prognostic scoring system for the early determination of the severity of acute pancreatitis, which they named the ‘bedside index of severity in acute pancreatitis’ (BISAP) [1, 2]....
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...5%) deaths among 397 cases [2] but, in our study, 82....
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TL;DR: Computed tomography was used to assess possible pancreatic disease in 352 patients and was found to be a reliable, often specific, and noninvasive method for detecting pancreatic neoplasms and pseudocysts.
Abstract: Computed tomography (CT) was used to assess possible pancreatic disease in 352 patients. It was found to be a reliable, often specific, and noninvasive method for detecting pancreatic neoplasms and pseudocysts. The use of CT has resulted in the diminished use of pancreatic angiography; effects of CT on patterns of utilization of other diagnostic methods are described.
70 citations