Comparing and Evaluating the Role of Early Predictors Like BISAP and Ranson Scoring System with Modified CT Severity Index in Assessing the Severity of Acute Pancreatitis

Abstract

Acute pancreatitis is a disorder characterized by acute necro-inflammatory changes of the pancreas and histologically marked by acinar cell destruction. It is one of the most common causes of hospitalization due to abdominal pain. Several classification systems have been proposed to assess the severity and prognosis of acute pancreatitis. Scores such as the Ranson and bedside index for severity in acute pancreatitis (BISAP) are useful for evaluating the severity and mortality of the disease. The revised Atlanta classification mainly focuses on the morphologic criteria for defining the various manifestations of acute pancreatitis outlined principally by means of CT and MRI. A case-series analysis study was conducted under the Department of Surgery, Government Medical College, Jammu, including 57 patients who presented with acute pancreatitis. The BISAP scores, along with Ranson scores and modified CT severity index scores (mCTSI), were calculated and compared using a preformed performa. The sensitivity, specificity, and area under the curve (AUC) of the BISAP and Ranson’s scoring systems were evaluated in patients who received CT scans, with mCTSI serving as the reference standard. The mean age of the study population was 46.49 years SD 14.11 with 14 (24.56%) men and 43 (75.44%) women. The men to women ratio was 0.32. Among the calculous etiology, cholelithiasis was the most common cause of acute pancreatitis, affecting 35 (61.40%) patients, followed by idiopathic acute pancreatitis. Out of 57 patients, 40 patients underwent CT scanning. Out of these 40 patients, 31 (77.5%) were classified as severe according to BISAP score with a cutoff of BISAP score ≥ 2, and 33 (82.5%) were classified as severe according to Ranson scoring system, with a cutoff of Ranson score ≥ 3. The sensitivity and specificity of BISAP were 90.90% and 85.71%, respectively. The sensitivity and specificity of Ranson were 93.93% and 71.42%, respectively. Ranson was more sensitive but less specific than BISAP. In our study, area under curve (AUC) of BISAP was 0.70, and area under curve (AUC) of Ranson was 0.94. Ranson scoring was more accurate than BISAP in predicting severe acute pancreatitis, according to area under curve (AUC). BISAP scoring is comparable to the Ranson score in predicting the severity of acute pancreatitis, with statistically insignificant p-value (p = 0.089). The bedside index for severity in acute pancreatitis (BISAP) offers a straightforward and timely means of identifying severe cases within 24 h of disease onset. Conversely, Ranson’s score retains its value in pinpointing patients at risk of severe acute pancreatitis and ensuing organ failure. In our study, p-value is > 0.05, which indicates that both BISAP and Ranson’s score are equally adept at assessing acute pancreatitis severity, serving as reliable prognostic tools for early patient intervention. However, Ranson’s score boasts superior sensitivity and specificity compared to BISAP, reinforcing its utility in clinical practice.

Appendix

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Table 5.

Table 6.

Table 7.

Table 4 Systemic inflammatory response syndrome (SIRS)

Table 5 Bedside index of severity in acute pancreatitis

Table 6 Ranson score of the patients was calculated based on the following data collection^[[25]]

Table 7 CT scoring was done according to the modified CT severity index (mCTSI). The score of the patients was calculated based on following data collection^[[15]]