Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Banks PA, Freeman ML (2006) Practice guidelines in acute pancreatitis. Am J Gastroenterol 101(10):2379–2400
Fagenholz PJ, Castillo CF, Harris NS, Pelletier AJ, Camargo CA Jr (2007) Increasing United States hospital admissions for acute pancreatitis, 1988-2003. Ann Epidemiol 17(7):491–497
Forsmark CE, Baillie J (2007) AGA Institute technical review on acute pancreatitis. Gastroenterology 132(5):2022–2044
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS (2013) Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 62(1):102–111
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(10):818–829
Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC (1974) Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 139(1):69–81
Taylor SL, Morgan DL, Denson KD, Lane MM, Pennington LR (2005) A comparison of the Ranson, Glasgow, and APACHE II scoring systems to a multiple organ system score in predicting patient outcome in pancreatitis. Am J Surg 189(2):219–222
Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA (2008) The early prediction of mortality in acute pancreatitis: a large population-based study. Gut 57(12):1698–1703
Balthazar EJ, Freeny PC (1994) van Sonnenberg E. Imaging and intervention in acute pancreatitis. Radiology 193(2):297–306
Mortele KJ, Wiesner W, Intriere L, Shankar S, Zou KH, Kalantari BN, Perez A (2004) vanSonnenberg E, Ros PR, banks PA, Silverman SG. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. AJR Am J Roentgenol 183(5):1261–1265
Kim BG, Noh MH, Ryu CH, Nam HS, Woo SM, Ryu SH, Jang JS, Lee JH, Choi SR, Park BH (2013) A comparison of the BISAP score and serum procalcitonin for predicting the severity of acute pancreatitis. Korean J Intern Med 28(3):322–329
Zhang J, Shahbaz M, Fang R, Liang B, Gao C, Gao H, Ijaz M, Peng C, Wang B, Niu Z, Niu J (2014) Comparison of the BISAP scores for predicting the severity of acute pancreatitis in Chinese patients according to the latest Atlanta classification. J Hepatobiliary Pancreat Sci 21(9):689–694
Dervenis C, Johnson CD, Bassi C, Bradley E, Imrie CW, McMahon MJ, Modlin I (1999) Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol 25(3):195–210
Singh VK, Wu BU, Bollen TL, Repas K, Maurer R, Johannes RS, Mortele KJ, Conwell DL, Banks PA (2009) A prospective evaluation of the bedside index for severity in acute pancreatitis score in assessing mortality and intermediate markers of severity in acute pancreatitis. Am J Gastroenterol 104(4):966–971
Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, Mortele KJ (2012) A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. Am J Gastroenterol 107(4):612–619
Yadav J, Yadav SK, Kumar S, Baxla RG, Sinha DK, Bodra P, Besra RC, Baski BM, Prakash O, Anand A (2016) 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. Gastroenterol Rep (Oxf) 4(3):216–220
Khanna AK, Meher S, Prakash S, Tiwary SK, Singh U, Srivastava A, Dixit VK(2013) Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg. :367581
Sharma RK, Sonkar K, Sinha N, Rebala P, Albani AE, Behari A, Reddy DN, Farooqui A, Kapoor VK (2016) Gallstones: a worldwide multifaceted disease and its correlations with gallbladder carcinoma. PLoS One 11(11):e0166351
Sharma V, Rana SS, Sharma RK, Kang M, Gupta R, Bhasin DK (2015) A study of radiological scoring system evaluating extrapancreatic inflammation with conventional radiological and clinical scores in predicting outcomes in acute pancreatitis. Ann Gastroenterol 28(3):399–404
Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A, Whitcomb DC (2010) Comparison of BISAP, Ranson’s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol 105(2):435–441
Gompertz M, Fernández L, Lara I, Miranda JP, Mancilla C, Berger Z (2012) Bedside index for severity in acute pancreatitis (BISAP) score as predictor of clinical outcome in acute pancreatitis: retrospective review of 128 patients. Rev Med Chil 140(8):977–983
Acknowledgements
We would like to thank Prof. N. Ananthakrishnan, Dean of PG studies and Research for his guidance during the entire duration of this study.
We would also like to thank our Vice Chancellor, Prof K.R. Sethuraman, for allowing us to perform this study at our institution.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical Statement
This study was conducted after obtaining approval from the Institute Ethical Committee.
Conflicts of Interest
The authors declare that they have no conflict of interest.
Funding
None.
Rights and permissions
About this article
Cite this article
Vaidya, Y., Vaithianathan, R. & Manickam, R. Comparative Evaluation of the BISAP Score with CT Severity Index in Predicting the Severity of Acute Pancreatitis. Indian J Surg 80, 353–358 (2018). https://doi.org/10.1007/s12262-017-1609-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-017-1609-z