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BACKGROUNDAIMS: The bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactorial scoring system. As more data are needed before clinical application, we compared BISAP, the serum procalcitonin (PCT), and other multifactorial scoring systems simultaneously.
Fifty consecutive acute pancreatitis patients were...
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Citations
... Our findings are also supported by other studies.In a prospective study of 50 patients with acute pancreatitis, the BISAP score demonstrated an accuracy of 84% in predicting SAP, exceeding the 76% accuracy of serum procalcitonin (when a cut-off value of ≥3.29 ng/mL was used) and matching the performance of the APACHE II score. Furthermore, logistic regression showed that BISAP had the best predictive significance [10]. ...
... While its inclusion in our analysis aimed to emphasize its relevance in assessing disease severity, we acknowledge that its high prognostic value does not exclusively pertain to biliary AP. Additionally, discrepancies in the reported accuracy of ProCT, such as the lower accuracy mentioned in the study conducted by Kim et al. [10], likely arise from differences in study design, patient populations, and timing of measurement. These factors underscore the variability of ProCT's diagnostic and prognostic utility, and we aimed to present both perspectives to provide a balanced view of its role in acute pancreatitis. ...
Background: Acute pancreatitis is a common condition with a variable prognosis. While the overall mortality rate of acute pancreatitis is relatively low, ranging between 3 and 5% in most cases, severe forms can result in significantly higher morbidity and mortality. Therefore, early risk assessment is crucial for optimizing management and treatment. The aim of the present study wasto compare simple prognostic markers and identify the best predictors of severity in patients with acute pancreatitis. Material and Methods: A retrospective analysis was carried outon 108 patients admitted in our center during one year with acute biliary pancreatitis. Acute pancreatitis severity was stratified based on the revised Atlanta criteria. Results: 108 subjects (mean age of 60.1 ± 18.6, 65.7% females) diagnosed with acute biliary pancreatitis were included. Based on the Atlanta criteria, 59.3% (64/108) of the subjects were classified as having mild acute biliary pancreatitis, 35.2% (38/108) as having a moderate–severe pancreatitis, and 5.5% (6/108) were classified as having severe acute pancreatitis. In univariate analysis, the following parameterswere associatedwith at least a moderate–severe form of acute pancreatitis: Balthazar score, fasting blood glucose (mg/dL), modified CTSI score, CRP values at 48 h, BISAP score at admission, CTSI score, Ranson score, duration of hospitalization (days), and the presence of leukocytosis (×1000/µL) (all p < 0.05).BISAP score at admission (AUC-0.91), CRP levels at 48 h (AUC-0.92), mCTSI (AUC-0.94), and CTSI score (AUC-0.93) had the highest area under the curve (AUC) for predicting the severity of acute pancreatitis. In multivariate analysis, the model including the following independent parameters was predictive for the severity of acute pancreatitis: CTSI score (p < 0.0001), BISAP score (p = 0.0082), and CRP levels at 48 h (p = 0.0091), respectively. The model showed a slightly higher AUC compared to the independent predictors (AUC-0.96). Conclusions: The use of a multiparametric prediction model can increase the accuracy of predicting severity in patients with acute biliary pancreatitis.
... The Glasgow criteria defined SAP as either fatal or associated with a complication that required a length of stay >20 days [22]. While the BISAP was derived and validated using mortality as the outcome [15], it has also been reported to correlate with organ failure [23][24][25] and SAP [26][27][28][29][30][31]. The most commonly recognized APSSS are cumbersome to calculate and require 48 hrs [32][33][34]. ...
Background
Severe acute pancreatitis (SAP) has a mortality rate as high as 40%. Early identification of SAP is required to appropriately triage and direct initial therapies. The purpose of this study was to develop a prognostic model that identifies patients at risk for developing SAP of patients managed according to a guideline-based standardized early medical management (EMM) protocol.
Methods
This single-center study included all patients diagnosed with acute pancreatitis (AP) and managed with the EMM protocol Methodist Acute Pancreatitis Protocol (MAPP) between April 2017 and September 2022. Classification and regression tree (CART®; Professional Extended Edition, version 8.0; Salford Systems, San Diego, CA), univariate, and logistic regression analyses were performed to develop a scoring system for AP severity prediction. The accuracy of the scoring system was measured by the area under the receiver operating characteristic curve.
Results
A total of 516 patients with mild (n=436) or moderately severe and severe (n=80) AP were analyzed. CART analysis identified the cutoff values: creatinine (CR) (1.15 mg/dL), white blood cells (WBC) (10.5 × 10⁹/L), procalcitonin (PCT) (0.155 ng/mL), and systemic inflammatory response system (SIRS). The prediction model was built with a multivariable logistic regression analysis, which identified CR, WBC, PCT, and SIRS as the main predictors of severity. When CR and only one other predictor value (WBC, PCT, or SIRS) met thresholds, then the probability of predicting SAP was >30%. The probability of predicting SAP was 72% (95%CI: 0.59-0.82) if all four of the main predictors were greater than the cutoff values.
Conclusions
Baseline laboratory cutoff values were identified and a logistic regression-based prognostic model was developed to identify patients treated with a standardized EMM who were at risk for SAP.
... In one study 42 , the AUC for mortality based on the BISAP score was 0.88, and the sensitivity was 92% and the specificity was 76% when the cut-off value of the BISAP score was 3. In a study by Dancu et al. 43 , the AUC for SAP based on the BISAP score was 0.77, and the sensitivity was 61% and the specificity was 88% when the cut-off value of the BISAP score was ≥2. Kim et al. 44 showed that BISAP is more accurate in predicting the severity of acute pancreatitis than CTSI scores in a Korean population. The accuracy of BISAP (≥ 2) at predicting severe acute pancreatitis was superior to CTSI score (≥4) 44 . ...
... Kim et al. 44 showed that BISAP is more accurate in predicting the severity of acute pancreatitis than CTSI scores in a Korean population. The accuracy of BISAP (≥ 2) at predicting severe acute pancreatitis was superior to CTSI score (≥4) 44 . In a meta-analysis including prospective cohort studies, BISAP was found to perform well in predicting SAP across different patient populations and severity levels 45 . ...
Purpose: The aim of this study is to investigate the power of disease severity scores to predict the development of Severe Acute Pancreatitis (SAP) and mortality in the early period over 65 years old diagnosed with acute pancreatitis in the emergency department.
Materials and Methods: We calculated RANSON (on admission) and Computed Tomography Severity Index (CTSI) in addition to Bedside Index for Severity in Acute Pancreatitis (BISAP) score on admission to the emergency department.
Results: One hundred and sixty patients (46.9% over 80 years of age) were included in the study. We observed statistically higher length of hospitalization, longer duration of stay in the intensive care unit, SAP and higher mortality in patients over 80 years of age. When we examined the ROC curve, we determined that the AUC values of the BISAP score were highest in both SAP and mortality estimation (AUC: 0.911, 95% CI 0.861-0.962; AUC: 0.918, 95% CI 0.864-0.9722, respectively). Binary logistic analysis indicated a 4.7-fold increased risk for SAP and a 12.3-fold increased mortality for each unit increase in BISAP score value.
Conclusion: BISAP may be a good predictor for SAP and mortality estimation on admission to the emergency department in patients over 65 years of age with acute pancreatitis.
... Generally, the cutoff value of the APACHE II score for predicting SAP is 8 points. Its sensitivity and specificity were 58-81% and 65.7-90%, respectively [31,32]. In this study, the specificity and sensitivity of MSAP+SAP were 76.47 and 21.8%, respectively. ...
Objective:
The objective of this study is to investigate the predictive value of a parametric model constructed by using procalcitonin, C-reactive protein (CRP) and D dimer within 48 h after admission in moderately severe and severe acute pancreatitis.
Methods:
A total of 238 patients were enrolled, of which 170 patients were moderately severe and severe acute pancreatitis (MSAP+SAP). The concentrations of procalcitonin, CRP and D dimer within 48 h after admission were obtained. The predictive value of the parametric model, modified computed tomography severity index (MCTSI), bedside index for severity in acute pancreatitis (BISAP), Ranson score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, modified Marshall score and systemic inflammatory response syndrome (SIRS) score of all patients was calculated and compared.
Results:
The area under receiver operator characteristic curve, sensitivity, specificity, Youden index and critical value of the parametric model for predicting MSAP+SAP were 0.853 (95% CI, 0.804-0.903), 84.71%, 70.59%, 55.30% and 0.2833, respectively. The sensitivity of the parametric model was higher than that of MCTSI (84.00%), Ranson score (73.53%), BISAP (56.47%), APACHE II score (27.65%), modified Marshall score (17.06%) and SIRS score (78.24%); the specificity of it were higher than that of MCTSI (52.94%) and Ranson score (67.65%), but lower than BISAP (73.53%), APACHE II score (76.47%), modified Marshall score (100%)and SIRS score (100.00%).
Conclusion:
The parametric model constructed by using procalcitonin 48 h, CRP 48 h and D dimer 48 h can be regarded as an evaluation model for predicting moderately severe and severe acute pancreatitis.
... 6 In Revised atlanta classification, Severity of the disease is categorized into 3 levels: mild, moderately severe, and severe on basis of local or systemic complications and organ failuree (as classified by the modified Marshal scoring system). 7 Ranson score is the commonly used in all over the world. The sensitivity, specificity and accuracy of Ranson score with ≥ 3 for SAP is 91.67%, 96.15% and 94% respectively. ...
Objective: To ascertain the diagnostic accuracy of BISAP score to predict severe acute pancreatitis keeping Ranson score as gold standard Study design: Descriptive Cross Sectional study Place and duration of study: Surgical Department, Combined Military Hospital Rawalpindi from January 2017 to July 2017. Methodology: 65 patients having history indicative of acute pancreatitis, serum lipase and serum amylase were measured. Patients with confirmed diagnosis of acute pancreatitis who consented for taking part in the research and achieving the inclusion and exclusion criteria were enrolled for study. Patients were evaluated by adequate history and thorough examination. All patients are investigated for Ranson score and BISAP score and divided into mild and severe pancreatitis on the basis of BISAPS and Ranson scoring. Results: In our study, mean+sd age was 44.92+8.92 years. Frequency of severe acute pancreatitis was 32.3%. Diagnostic accuracy of BISAP score to predict severe acute pancreatitis keeping Ranson score as gold standard had 80.9% of sensitivity, 81% of specificity, 68% of PPV and 90% of NPV. Conclusion: BISAP score have an excellent accuracy for prediction of severe acute pancreatitis as Ranson score. BISAP score can be used as tool for recognition of severe acute pancreatitis within 24 hours in simple and precise manner. Keywords: Severe acute pancreatitis, Prediction, BISAP score, Ranson score, Accuracy
... Despite the Chinese and American leadership in the number of publications, one should take into consideration a possible numerical overestimation bias due to their great economic and demographic power (112) . (FIGURE 2) China (41.2% = 7/17) and the United States (11.8% = 2/17) also recorded the largest number of publications among studies that just compared the efficiency of prognostic markers (C-reactive protein, hematocrit, red cell distribution width -RDW, serum calcium, thrombin-antithrombin III complex, brain natriuretic peptide -BNP, procalcitonin, apolipoprotein B, pentraxin 3 -PTX3, growth differentiation factor 15 -GDF-15, urea and body mass index) and of old rating scores (Ranson, Apache II, BISAP, PANC 3, DBC) to the new concepts aimed at determining the severity of patients with acute pancreatitis, which were released after the Atlanta classification revision (TABLE 2) (16,38,41,60,67,87,99) . However, European countries such as Spain (11.8% = 2/17) and the United Kingdom (11.8% = 2/17) The herein selected 89 valid studies were recorded and stratified as to whether, or not, they applied the recommendations and/or concepts proposed and disclosed after the Atlanta Classification revision. ...
... The studies applying these recommendations were those that, based on these principles, established and determined the severity of the investigated patients (mild, moderately severe, severe) in order to evaluate their clinical evolution (TABLE 1) (16, . (38) 2015 153 Diagnosis China Joon HC (39) 2015 153 Severity Classification South Korea Huh JH (40) 2018 191 Severity Classification South Korea Kim BG (41) 2013 50 Severity Classification / Diagnosis South Korea Cho JH (42) 2018 60 Severity Classification South Korea Mikolasevic (43) 2016 198 Severity Classification Croatia Mikolasevic (44) 2016 609 Severity Classification / Diagnosis Croatia Trgo G (45) 2016 40 Severity Classification Croatia Vujasinovic (46) 2014 100 Severity Classification Slovenia María CP (47) 2016 56 Severity Classification Spain Bozhychko (48) 2017 233 Severity Classification Spain Ellery KM (49) 2017 122 Severity Classification / Diagnosis USA Sugimoto M (50) 2015 663 Severity Classification USA Gougol A (51) 2017 500 Severity Classification USA Vipperla K (52) 2017 121 Severity Classification USA Vlada AC (53) 2013 67 Severity Classification USA Buxbaum J (54) 2014 25 Severity Classification USA Buxbaum J (55) 2016 60 Severity Classification USA Dimagno M (56) 2014 223 Diagnosis USA Bishu S (57) 2018 357 Severity Classification USA Bem MD (58) 2016 175 Severity Classification USA Nieminen A (59) 2014 25 Diagnosis Finland Nikkola A (60) 2017 35 Severity Classification Finland Nukarinen E (61) 2016 176 Severity Classification Finland Bakker OJ (62) 2013 639 Severity Classification Netherlands Párniczky A (63) 2015 -* Severity Classification Hungary Poropat G (64) 2012 162 Severity Classification /Complications India John BJ (65) 2017 134 Severity Classification India Stirling AD (66) 2017 337 Severity Classification Ireland Losurdo G (67) 2016 90 Severity Classification Italy Sugawara S (68) 2017 23 Severity Classification Japan Andrius K (69) 2016 142 Severity Classification / Diagnosis Lithuania Chacó MA (70) List of studies that compared the efficiency of prognostic markers (chemical / biological / clinical parameter) and of old rating scores to the new concepts used to determine the severity of patients, which were disclosed after the Atlanta classification revision. ...
Background:
New recommendations for the management of patients with acute pancreatitis were set after the Atlanta Classification was revised in 2012.
Objective:
The aim of the present systematic review is to assess whether these recommendations have already been accepted and implemented in daily medical practices.
Methods:
A systematic literature review was carried out in studies conducted with humans and published in English and Portuguese language from 10/25/2012 to 11/30/2018. The search was conducted in databases such as PubMed/Medline, Cochrane and SciELO, based on the following descriptors/Boolean operator: "Acute pancreatitis" AND "Atlanta". Only Randomized Clinical Trials comprising some recommendations released after the revised Atlanta Classification in 2012 were included in the study.
Results:
Eighty-nine studies were selected and considered valid after inclusion, exclusion and qualitative evaluation criteria application. These studies were stratified as to whether, or not, they applied the recommendations suggested after the Atlanta Classification revision. Based on the results, 68.5% of the studies applied the recommendations, with emphasis on the application of severity classification (mild, moderately severe, severe); 16.4% of them were North-American and 14.7% were Chinese. The remaining 31.5% just focused on comparing or validating the severity classification.
Conclusion:
Few studies have disclosed any form of acceptance or practice of these recommendations, despite the US and Chinese efforts. The lack of incorporation of these recommendations didn't enable harnessing the benefits of their application in the clinical practice (particularly the improvement of the communication among health professionals and directly association with the worst prognoses); thus, it is necessary mobilizing the international medical community in order to change this scenario.
... Simoes et al. in their study revealed that Ranson score showed sensitivity of 91.2% for the prediction of the severity of the disease but the specificity was less when compared to the present study [20]. Kim et al. in their research stated that depending on the ANC the Ranson scoring system depicts the highest accuracy for presuming the severity of disease [21]. Khanna et al. suggested that the levels of procalcitonin had an AUC of 0.88 for the presumption of the severity of AP [18]. ...
Background: Acute Pancreatitis (AP) is an easily seen and recurring disorder. This condition is characterized by long term pain in the abdomen area, frequent exacerbations of the disease, and insufficiency of the exocrine and/or endocrine. The Atlanta Classification is accounted as the universal method for the evaluation of the acute pancreatitis severity. To evaluate the severity of the AP, scoring systems like Evaluation (APACHE)-Ⅱ and CT Severity index are widely practised. The listed scoring systems looks complicated and tough to perform though with average sensitivity. A newer and advanced scoring system has been introduced termed Bedside Index for the evaluation of severity of the AP. This has been reported to be accurate and an easy way to identify the risk associated in the patients suffering from AP. Objectives: 1. The present study evaluates the newer scoring system for its accuracy in assessing the severity of acute pancreatitis. 2. To estimate association between stages of AP and procalcitonin level. METHODOLOGY:A time bound prospective, cross sectional study in which patients presenting with AP at AVBRH were examined and assessed. The study was implemented in Department of Medicine, AVBRH that is a teaching tertiary care hospital located in the Wardha district sub urban area. The study was performed after issuing the approval from institute ethical committee. The patients who visited with the chief complaint of abdominal pain that is acute in nature were examined. The investigations for evaluation was done 4095 http://annalsofrscb.ro including Serum amylase and ultrasonography abdomen. The final diagnosis was confirmed depending on the Atlanta criteria for AP. EXPECTED RESULTS: The study aims to predict outcomes of different scores in AP patients and as previous studies which has been conducted outside India, have concluded that out of all scoring systems in comparison, the Modified Glasgow Scale was presented with maximum sensitivity to evaluate the seriousness of the acute pancreatitis.
... The authors demonstrated that the accuracy of the BISAP score with a cutoff value of ≥3 for predicting severe AP was 76.2% with a kappa value of 0.34. Kim et al. [21] reported a higher sensitivity of 84% for BISAP with a lower cut-off value of 2 in predicting severe AP. ...
Background:
Prognostic prediction and estimation of severity at early stages of acute pancreatitis (AP) are crucial to reduce the complication rates and mortality. The objective of the present study is to evaluate the predicting ability of different clinical and radiological scores in AP.
Methods:
We retrospectively collected demographic and clinical data from 159 patients diagnosed with AP admitted to Canakkale Onsekiz Mart University Hospital between January 2017 and December 2019. Bedside index for severity AP (BISAP), and acute phys-iology and chronic health evaluation II (APACHE II) score at admission, Ranson and modified Glasgow Prognostic Score (mGPS) score at 48 h after admission were calculated. Modified computed tomography severity index (CTSI) was also calculated for each patient. Area under the curve (AUC) was calculated for each scoring system for predicting severe AP, pancreatic necrosis, length of hospital stay, and mortality by determining optimal cutoff points from the (ROC) curves.
Results:
mGPS and APACHE II had the highest AUC (0.929 and 0.823, respectively) to predict severe AP on admission with the best specificity and sensitivity. In predicting mortality BISAP (with a sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 75.0%, 70.9%, 98.2%, and 12.0%, respectively, [AUC: 0.793]) and APACHE II (with a sensitivity, specificity, NPV and PPV of 87.5%, 86.1%, 99.2%, and 25.0%, respectively, [AUC: 0.840]).
Conclusion:
mGPS can be a valuable tool in predicting the patients more likely to develop severe AP and maybe somewhat better than BISAP score, APACHE II Ranson score, and mCTSI.
... The clinical course of AP is usually mild and often resolves without sequelae. Nonetheless, between 10 and 20 % of patients experience a severe AP attack (3), resulting in an intense inflammatory response, a variety of local and systemic complications, a prolonged hospital course, significant morbidity and mortality. In such patients, the acute inflamma-tory response may progress to Systemic Inflammatory Response Syndrome [SIRS], multiorgan failure, and / or pancreatic necrosis. ...
... Although the assessment of Acute Physiology and Chronic Health Evaluation (APACHE) II score at the time of drainage would have further helped to remove confounding effect, this data was not available for all patients. Performance of procalcitonin levels is comparable to APACHE II score according to published studies; hence, we utilized procalcitonin levels (within 24 h prior to procedure) which were comparable between the two groups [22,23]. The limitations of this study are its retrospective nature. ...
Objective:
To evaluate the impact of initial catheter size on the clinical outcomes in acute pancreatitis (AP).
Methods:
This retrospective study comprised consecutive patients with AP who underwent percutaneous catheter drainage (PCD) between January 2018 and May 2019. Three hundred fifteen consecutive patients underwent PCD during the study period. Based on the initial catheter size, patients were divided into group I (≤ 12 F) and group II (> 12 F). The differences in the clinical outcomes between the two groups, as well as multiple subgroups (based on the severity, timing of drainage, and presence of organ failure (OF)), were evaluated.
Results:
One hundred forty-six patients (mean age, 41.2 years, 114 males) fulfilled the inclusion criteria. Ninety-nine (67.8%) patients had severe AP based on revised Atlanta classification. The mean pain to PCD was 22 days (range, 3-267 days). Mean length of hospitalization (LOH) was 27.9 ± 15.8 days. Necrosectomy was performed in 20.5% of patients, and mortality was 16.4%. Group I and II comprised 74 and 72 patients, respectively. There was no significant difference in baseline characteristics, except for a greater number of patients with OF in group II (p = 0.048). The intensive care unit stay was significantly shorter, and multiple readmissions were less frequent in group II (p = 0.037 and 0.013, respectively). Patients with severe AP and moderately severe AP in group II had significantly reduced rates of readmissions (p = 0.035) and significantly shorter LOH (p = 0.041), respectively.
Conclusion:
Large-sized catheters were associated with better clinical outcomes regardless of disease severity and other baseline disease characteristics.
Key points:
• Larger catheter size for initial PCD was associated with better clinical outcomes in AP. • The benefits were independent of the severity of AP, timing of PCD (ANC vs. WON) and presence of organ failure.
