Skip to main content

Advertisement

SpringerLink
Log in

Role of bedside pancreatic scores and C-reactive protein in predicting pancreatic fluid collections and necrosis

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Acute pancreatitis is a disease with variable outcome; the course of the disease can be modified by early aggressive management in patients with severe pancreatitis. Easily calculable pancreatic scores and investigations can help to triage these patients. We aimed to determine the role of bedside index for severity in acute pancreatitis (BISAP), harmless acute pancreatitis score (HAPS), and systemic inflammatory response syndrome (SIRS) scores on day of admission and C-reactive protein (CRP) at 48 h for predicting the presence of pancreatic fluid collection (PFC) and necrosis on CT scans done at 72 h.

Methods

Of a total of 114 consecutively seen patients of pancreatitis, 64 with acute pancreatitis were enrolled in the study. All individuals had the pancreatitis predicting scores calculated at the time of admission, CRP at 48 h, and contrast-enhanced computed tomography (CECT) abdomen at 72 h from admission.

Results

The study population of 64 (55 male) had a mean (+SD) age of 37.7 ± 13 years. Alcohol was the most common (68.8%) etiology in these patients. Based on CECT, patients were divided into 2 groups; group 1 with 41 patients who had mild pancreatitis and group 2 with 23 patients who had pancreatic fluid collection with or without necrosis (PFCN). PFCN were seen in 19 (29.7%) of patients with 2 or more SIRS criteria, 17 (26.6%) of patients with BISAP score ≥3, and 16 patients (25.0%) with HAPS >0 respectively. All three scores were able to predict PFCN significantly. CRP >150 mg/L was noted in 23 patients and was able to predict the presence of fluid collections (p=0.0002) and pancreatic necrosis (p = 0.0004) on CT.

Conclusion

BISAP, HAPS, and SIRS scores and CRP of 150 mg/L all correlated significantly with the occurrence of fluid collections and pancreatic necrosis on CT at 72 h. None of the scores was superior to the other in this respect.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Beger HG, Rau B, Isenmann R. Prevention of severe change in acute pancreatitis: prediction and prevention. J Hepatobiliary Pancreat Surg. 2001;8:140–7.

  2. Tsiotos GG, Luque-de Leon E, Söreide JA, et al. Managementof necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique. Am J Surg. 1998;175:91–8.

    Article  CAS  PubMed  Google Scholar 

  3. Brivet FG, Emilie D. Pro- and anti-inflammatory cytokines during acute severe pancreatitis: an early and sustained response, although unpredictable of death. Parisian study group on acute pancreatitis. Crit Care Med. 1999;27:749–55.

    Article  CAS  PubMed  Google Scholar 

  4. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128:586–90.

    Article  PubMed  Google Scholar 

  5. Acute Pancreatitis Classification Working Group. Revision of the Atlanta classification of acute pancreatitis 2008; cited 2011; Available from: www.pancreasclub.com/resources/AtlantaClassification.pdf.

  6. Brun A, Agarwal N, Pitchumoni CS. Fluid collections in and around the pancreas in acute pancreatitis. J Clin Gastroenterol. 2011;45:614–25.

    Article  PubMed  Google Scholar 

  7. Morgan DE. Imaging of acute pancreatitis and its complications. Clin Gastroenterol Hepatol. 2008;6:1077–85.

    Article  PubMed  Google Scholar 

  8. Brun A, Neelam, Pitchumoni CS, Agrawal RM. Prognosis in acute pancreatitis. Pract Gastroenterol. 2012;3:16e41.

  9. Khanna AK, Meher S, Prakash S, et al. 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. 2013;2013:367581.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Castelli GP, Pognani C, Meisner M, Stuani A, Bellomi D, Sgarbi L. Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction. Crit Care. 2004;8:R234–42.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sekimoto M, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006;13:10–24.

  12. Sandberg AA, Borgström A. Early prediction of severity in acute pancreatitis. Is this possible? JOP. 2002;3:116–25.

    PubMed  Google Scholar 

  13. Dambrauskas Z, Gulbinas A, Pundzius J, Barauskas G. Value of the different prognostic systems and biological markers for predicting severity and progression of acute pancreatitis. Scand J Gastroenterol. 2010;45:959–70.

    Article  CAS  PubMed  Google Scholar 

  14. Werner J, Hartwig W, Uhl W, Muller C, Buchler MW. Useful markers for predicting severity and monitoring progression of acute pancreatitis. Pancreatology. 2003;3:115–27.

    Article  CAS  PubMed  Google Scholar 

  15. Dervenis C, Johnson CD, Bassi C, et al. Diagnosis, objective assessment of severity,and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol. 1999;25:195–210.

    CAS  PubMed  Google Scholar 

  16. Wang X, Cui Z, Li H, et al. Nosocomial mortality and early prediction of patients with severe acute pancreatitis. J Gastroenterol Hepatol. 2010;25:1386–93.

    Article  CAS  PubMed  Google Scholar 

  17. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644–55.

    Article  CAS  PubMed  Google Scholar 

  18. Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57:1698–703.

    Article  CAS  PubMed  Google Scholar 

  19. Lankisch PG, Weber-Dany B, Hebel K, Maisonneuve P, Lowenfels AB. The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratification of nonsevere disease. Clin Gastroenterol Hepatol. 2009;7:702–5. quiz 607

    Article  PubMed  Google Scholar 

  20. Akhtar AJ, Shaheen M. Extrapancreatic manifestations of acute pancreatitis in African-American and Hispanic patients. Pancreas. 2004;29:291–7.

    Article  PubMed  Google Scholar 

  21. Jacobs ML, Daggett WM, Civette JM, et al. Acute pancreatitis: analysis of factors influencing survival. Ann Surg. 1977;185:43–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ignjatovic S, Majkic-Singh N, Radenkovic D, Gvozdenovic M, Mitrovic M. Diagnosis, assessment of severity and management of acute pancreatitis. Jugoslovenska Medicinska Biohemija. 2004;23:229–33.

  23. Stimac D, Mikolasevic I, Krznaric-Zrnic I, Radic M, Milic S. Epidemiology of acute pancreatitis in the North Adriatic Region of Croatia during the last ten years. Gastroenterol Res Pract. 2013;2013:956149.

  24. Banks PA, Freeman ML. Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–400.

    Article  PubMed  Google Scholar 

  25. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.

    Article  PubMed  Google Scholar 

  26. Papachristou GI, Muddana V, Yadav D, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010;105:435–41. quiz 442

    Article  PubMed  Google Scholar 

  27. Park JY, Jeon TJ, Ha TH, et al. Bedside index for severity in acute pancreatitis: comparison with other scoring systems in predicting severity and organ failure. Hepatobiliary Pancreat Dis Int. 2013;12:645–50.

    Article  PubMed  Google Scholar 

  28. Gompertz M, Fernández L, Lara I, Miranda JP, Mancilla C, Berger Z. 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. 2012;140:977–83.

    Article  PubMed  Google Scholar 

  29. Singh VK, Wu BU, Bollen TL, et al. Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clin Gastroenterol Hepatol. 2009;7:1247–51.

  30. Alfonso V, Gómez F, López A, et al. Value of C-reactive protein level in the detection of necrosis in acute pancreatitis. Gastroenterol Hepatol. 2003;26:288–93.

    Article  CAS  PubMed  Google Scholar 

  31. Cardoso FS, Ricardo LB, Oliveira AM, et al. C-reactive protein prognostic accuracy in acute pancreatitis: timing of measurement and cutoff points. Eur J Gastroenterol Hepatol. 2013;25:784–9.

    Article  CAS  PubMed  Google Scholar 

  32. Wilson C, Heads A, Shenkin A, Imrie CW. C-reactive protein, antiproteases and complement factors as objective markers of severity in acute pancreatitis. Br J Surg. 1989;76:177–81.

    Article  CAS  PubMed  Google Scholar 

  33. United Kingdom guidelines for the management of acute pancreatitis. British Society of Gastroenterology. Gut. 1998;42 Suppl 2:S1–13.

  34. Al-Bahrani AZ, Ammori BJ. Clinical laboratory assessment of acute pancreatitis. Clin Chim Acta. 2005;362:26–48.

    Article  CAS  PubMed  Google Scholar 

  35. Mann DV, Hershman MJ, Hittinger R, Glazer G. Multicentre audit of death from acute panceatitis. Br J Surg. 1994;81:890–3.

Download references

Author information

Authors and Affiliations

  1. Institute of Gastroenterology, SRM Institutes for Medical Sciences, 1 Jawaharlal Nehru Road, Vadapalani, Chennai, 600 026, India

    Doraiswami Babu Vinish & S. Arulprakash

  2. Department of Gastroenterology, St. Johns Medical College, Sarjapur Road, Bengaluru, 560 034, India

    Vishnu Abishek

  3. Department of Community Medicine, Coimbatore Medical College, Avinashi Road, Peelamedu, Coimbatore, 641 018, India

    K. Sujatha

  4. Kilpauk Medical College, Government Peripheral Hospital, 822, Poonamallee High Road, Kilpauk, Chennai, 600 010, India

    Rajkumar Solomon

  5. Sri Ramachandra Medical College, 1, Ramachandra Nagar, Porur, Chennai, 600 116, India

    P. Ganesh

Authors
  1. Doraiswami Babu Vinish
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vishnu Abishek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Sujatha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Arulprakash
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rajkumar Solomon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Ganesh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Doraiswami Babu Vinish.

Ethics declarations

Conflict of interest

DBV, VA, KS, SA, RS, and PG declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was performed in a manner to conform to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vinish, D.B., Abishek, V., Sujatha, K. et al. Role of bedside pancreatic scores and C-reactive protein in predicting pancreatic fluid collections and necrosis. Indian J Gastroenterol 36, 43–49 (2017). https://doi.org/10.1007/s12664-017-0728-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-017-0728-6

Keywords

Search

Navigation