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Pooled results of BISAP score, Ranson score, and APACHEII score for the prediction of clinical outcomes.
Source publication
Purpose:
The Bedside Index for Severity in Acute Pancreatitis (BISAP) score has been developed to identify patients at high risk for mortality or severe disease early during the course of acute pancreatitis. We aimed to undertake a meta-analysis to quantify the accuracy of BISAP score for predicting mortality and severe acute pancreatitis (SAP)....
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Sepsis is the leading cause of mortality in patients with severe acute pancreatitis (SAP). High mortality rate in patients with SAP is mainly associated with purulent and inflammatory process in parapancreatic fat. Early laboratory diagnosis of infection is vitally important for timely indications for surgery and successful therapy. Aim of study Th...
Introduction:
This paper reports preliminary data of an ongoing study that evaluates the association of systemic inflammatory response (SIRS) with early severe acute pancreatitis (ESAP) and compensatory anti-inflammatory response syndrome (characterized by HLA-DR down-regulation) with infected pancreatic necrosis (IPN).
Methods:
Consecutive pati...
Purpose:
Severe acute pancreatitis (SAP) is a life-threatening inflammatory syndrome of the pancreas. This study aimed to analyze the clinical significance of runt-associated transcription factor 3 (RUNX3) and fibroblast growth factor receptor 2 (FGFR2) expression alterations in SAP.
Methods:
This study included 18 SAP patients in Wuzhong People...
Background
Stroke-associated pneumonia (SAP) is associated with a poor prognosis and a high mortality rate in stroke patients. However, the accuracy of early prediction of SAP is insufficient, and there is a lack of effective prognostic evaluation methods. Therefore, in this study, we investigated the predictive value of the Oxford Acute Severity o...
Severe acute pancreatitis (SAP) presents with an aggressive clinical presentation and high lethality rate. Early prediction of the severity of acute pancreatitis will help physicians to further precise treatment and improve intervention. This study aims to construct a composite model that can predict SAP using inflammatory markers. 212 patients wit...
Citations
... While the BISAP score was not significant (p = 0.100), it was found that having a Ranson score >4 increased the risk of mortality by 9.07 times compared to having a score of ≤4 (p = 0.038). In a published meta-analysis [17], a cut-off value of >2 was found for the BISAP score and at this cutoff value, while the BISAP score had high specificity and low sensitivity for mortality, it was found that having an Apache II score >7 had low specificity and high sensitivity. In the same meta-analysis, the Ranson score achieved the highest AUC value in mortality with a >2 cut-off value. ...
... In recent studies related to the Ranson score [14,19,20], it has been stated that it demonstrates performance close to or superior to other scoring systems, and its specificity is higher than these scoring systems. Gao et al. [17] reported that the Ranson score provides higher AUC values for mortality compared to the APACHE II and BISAP scoring systems. In our study, in line with this data, the Ranson score provided the best AUC value for mortality, and the specificity of the Ranson score was found to be higher in mortality and disease severity. ...
Background and study aim
The aim of the study is to demonstrate the effectiveness of different scoring systems and inflammatory markers in predicting the severity, local complications, pancreatic necrosis, and mortality of acute pancreatitis (AP).
Materials and methods
The data of 357 patients whom the severity of pancreatitis was classified according to the Revised Atlanta Classification System diagnosed with AP were retrospectively examined. Also The APACHE II, BISAP, mCTSI, and Ranson scores of all patients were calculated. After determining the cut-off values for scoring systems and inflammatory markers with ROC analysis, comparison for AP severity, local complication, necrosis, and mortality.
Results
In the study, 2.8% of patients had severe pancreatitis. It was found that the risk of developing local complications increased 2.82 times in cases with an 48th-h CRP value >192 mg/L compared to those below this threshold, and 48.96 times in cases with an mCTSI score >2 compared to ≤ 2 cases. It was found that having a Ranson score >4 increased the risk of mortality by 9.07 times compared to having a score of ≤4 (p = 0.038). It was observed that having a BISAP >2 increased the risk of severe AP by 11.79 times compared to ≤2. In cases where the 48th-h NLR value was >13.33, the risk of severe AP was found to have increased by 5.85 times.
Conclusion
Although the superiority of scoring systems could not be demonstrated in our study, CRP and MCTSI for local complications, BISAP for severity and Ranson score for mortality were the determining variables.
... Traditional scoring systems such as APACHE II and SOFA are time-consuming and require extensive clinical data (24)(25)(26). In contrast, the nCD64 index showed a strong positive correlation with the APACHE II score, a widely used tool for assessing disease severity, suggesting that nCD64 could offer a simpler and more accessible alternative for rapid risk stratification (27)(28)(29)(30). ...
Objective
Effective early diagnosis and timely intervention in acute pancreatitis (AP) are essential for improving patient outcomes. This study aims to evaluate the clinical utility of the neutrophil CD64 index (nCD64) in stratifying patients with SAP and assessing mortality risk.
Methods
A total of 302 AP patients were enrolled and divided into a training cohort (n = 226) and a validation cohort (n = 76). Venous blood samples were collected within 24 hours of admission, and the nCD64 index was measured via flow cytometry. Other clinical parameters, including C-reactive protein (CRP) and procalcitonin (PCT), were also recorded. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic value of the nCD64 index and its capacity to predict mortality risk.
Results
ROC curve analysis identified a cutoff value of 1.45 for the nCD64 index. Patients with nCD64 > 1.45 had significantly higher risks of complications, including systemic inflammatory response syndrome (SIRS), acute respiratory distress syndrome (ARDS), multiple organ failure (MOF), and death. Over 65% of patients with acute pancreatitis (AP) can be effectively risk-stratified at a low cost, and it has been demonstrated that AP patients with an nCD64 value ≤ 1.45 have an extremely low mortality rate (no mortality in present training and validation cohort). Kaplan-Meier survival analysis revealed a significant survival difference between high-risk (nCD64 > 1.45) and low-risk groups (p < 0.001).
Conclusion
The nCD64 index is an effective tool for early identification of SAP patients, allowing for the classification of over 65% of cases as low-risk for mortality.
... As with many areas of medicine where multiple options are still being studied, no single approach has emerged as definitively superior to others in large-scale comparisons. [11][12][13][14][15][16] While there is no 'gold standard' prognostic score for predicting SAP, the Bedside Index of Severity of Acute Pancreatitis (BISAP) score is one of the more accurate. Due to its simplicity and the fact that it does not require data from 48 hours after admission, BISAP is particularly applicable in everyday clinical practice. ...
Acute pancreatitis (AP) is a heterogeneous inflammation of the pancreas, most frequently attributable to gallstones or alcohol. AP accounts for an estimated 300 000 patients admitted each year in the USA, and an estimated US$2.6 billion/year in hospitalization costs. Disease severity is classified as mild, moderate, or severe, dependent on the presence or degree of concomitant organ failure. Locally, pancreatitis may be complicated by fluid collections, necrosis, infection, and hemorrhage. Infection of necrotizing pancreatitis (NP) is associated with a doubling of mortality risk. The modern management of AP is evolving. Recent data suggest a shift from normal saline to lactated Ringer’s solution, and from aggressive to more judicious volume resuscitation. Similarly, while historical wisdom advocated keeping patients nothing by mouth to ‘rest the pancreas’, recent data convincingly show fewer complications and reduced mortality with early enteral nutrition, when tolerated by the patient. The use of antibiotics in NP is controversial. Current recommendations suggest reserving antibiotics for cases with highly suspected or confirmed infected necrosis, as well as in patients with biliary pancreatitis complicated by acute cholecystitis or cholangitis. Regarding the management of local complications, control of acute hemorrhage can be attained either endovascularly or via laparotomy. Abdominal compartment syndrome is associated with a mortality risk of 50%–75%. Routine monitoring of intra-abdominal pressure is recommended in patients at high risk. Pancreatic pseudocysts require intervention in symptomatic patients or those with infection or other complications. Endoscopic transmural drainage may be considered as the first step when technically feasible. Necrotizing pancreatitis without suspicion of infection is often managed medically, while the delay, drain, debride approach remains the standard of care for the vast majority of infected pancreatic necrosis. Robotic surgery, in appropriately selected patients, allows for a one-step approach, and merits further study to explore its initially promising results.
... The CCI classification categorized patients based on predefined criteria: 0 points indicated the absence of specific comorbidities and a low risk with higher survival rates; 1-2 points indicated one to two mild comorbidities, representing moderate risk; 3-4 points indicated a moderate comorbidity burden, associated with moderate to high risk; 5-6 points indicated significant comorbidities requiring close monitoring, representing high risk; and 7 points or more indicated severe comorbidities, associated with lower survival rates and higher treatment risks. Furthermore, the severity of acute pancreatitis was assessed using the Bedside Index for Severity in Acute Pancreatitis (BISAP) score, which categorized scores into three groups: scores of 0 or1 indicated mild severity, scores of 2 indicated moderate severity, and scores of 3 or above indicated severe severity [8,9]. The BISAP score included parameters such as elevated BUN levels (> 25 mg/dL), impaired mental status, SIRS criteria, age over 60 years, and the presence of pleural effusion. ...
Objective
Acute pancreatitis is a critical condition in the intensive care unit (ICU), often complicated by systemic issues, which may benefit from heparin therapy due to its anti-inflammatory and anticoagulant properties. However, the optimal duration of heparin therapy remained unclear. This retrospective study aimed to evaluate the association between heparin therapy duration and mortality outcomes in patients diagnosed with acute pancreatitis.
Method
This retrospective study utilized data from the Medical Information Mart for Intensive Care (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD), including 1705 patients diagnosed with acute pancreatitis between 2008 and 2019. Restricted cubic splines (RCS) were employed to analyze the non-linear relationship between heparin therapy duration and 30-day and 90-day mortality. Patients were categorized into four groups based on quartiles: < 4 days, 4–7 days, 8–14 days, and > 14 days, using characteristics identified in the RCS curves, with 4–7 days as the reference. Cox multivariate regression and Kaplan-Meier analysis assessed the association between these groups and mortality, with 30-day mortality as the primary outcome and 90-day mortality as the secondary outcome.
Result
The relationship between heparin therapy duration and mortality at 30 and 90 days in patients with acute pancreatitis exhibited a J-shaped curve, with the lowest mortality observed around 7 days for both 30-day and 90-day mortality. Heparin therapy durations less than 4 days were significantly associated with higher 30-day mortality (HR: 2.57, 95% CI: 1.53–4.30) and increased 90-day mortality (HR: 1.57, 95% CI: 1.07–2.32), with mortality stabilizing beyond 7 days of therapy. Subgroup analysis stratified by severity consistently supported these findings.
Conclusion
In critically ill patients with acute pancreatitis, heparin therapy lasting less than 4 days was associated with increased 30-day and 90-day mortality, whereas the lowest mortality was observed among patients receiving heparin therapy for approximately 7 days.
... The unpredictable trajectory of AP, ranging from mild selflimiting inflammation to severe multi-organ failure, underscores an urgent need for reliable biomarkers that can accurately stratify disease severity and facilitate early intervention. Although current clinical tools such as scoring systems like the Ranson Score and the Bedside Index for Severity in Acute Pancreatitis are useful, they often lack the precision and timeliness required for accurate risk prediction [3,4]. In the initial section of this editorial, we provide an overview of biomarkers that exhibit specific utility (Table 1), although their specificity in elucidating the molecular mechanisms underlying AP pathogenesis remains limited [5,6]. ...
In this editorial, we critically evaluate the recent article by Niu et al , which explores the potential of phospholipase D2 (PLD2) as a biomarker for stratifying disease severity in acute pancreatitis (AP). AP is a clinically heterogeneous inflammatory condition that requires reliable biomarkers for early and accurate classification of disease severity. PLD2, an essential regulator of neutrophil migration and inflammatory responses, has emerged as a promising candidate. Although current biomarkers such as C-reactive protein and procalcitonin provide general indications of inflammation, they lack specificity regarding the molecular mechanisms underlying AP progression. Recent studies, including the research conducted by Niu et al , suggest an inverse correlation between PLD2 expression and AP severity, offering both diagnostic insights and mechanistic understanding. This editorial critically evaluates the role of PLD2 as a biomarker in the broader context of AP research. Evidence indicates that decreased levels of PLD2 are associated with increased neutrophil chemotaxis and cytokine release, contributing to pancreatic and systemic inflammation. However, several challenges remain, including the need for large-scale validation and functional studies to establish causation, and standardization of measurement protocols. Additionally, further investigation into the temporal dynamics of PLD2 expression and its variability across diverse populations is warranted. Looking ahead, PLD2 holds the potential to revolutionize AP management by integrating molecular diagnostics with precision medicine. The utilization of large-scale multi-omics approaches and advancements in diagnostic platforms could position PLD2 as a fundamental biomarker for early diagnosis, prognosis, and potentially therapeutic targeting. While promising, it is crucial to conduct critical evaluations and rigorous validations of PLD2’s role to ensure its efficacy in improving patient outcomes.
... C-reactive protein (CRP) là một xét nghiệm đơn giản, dễ thực hiện và không tốn kém. CRP do gan sản xuất dưới kích thích của interleukin-1 và interleukin-6, được xem là yếu tố dự báo hoại tử tụy, nhiễm trùng và hội chứng đáp ứng viêm toàn thân (systemic inflammatory response syndrome -SIRS) [4]. Xét nghiệm CRP có giá trị tiên lượng viêm tụy cấp nặng với độ nhạy 38-61% và độ đặc hiệu 89-90% [5]. ...
... Xét nghiệm CRP có giá trị tiên lượng viêm tụy cấp nặng với độ nhạy 38-61% và độ đặc hiệu 89-90% [5]. Theo dõi liên tục mức CRP giúp đánh giá phản ứng với điều trị và tình trạng viêm, đặc biệt sau 48 giờ [4]. Tại Việt Nam, nghiên cứu về CRP trong tiên lượng viêm tụy cấp còn hạn chế, cần thêm nghiên cứu để làm rõ vai trò của CRP trong điều trị. ...
Mục tiêu: Xác định nồng độ CRP và thang điểm BISAP ở bệnh nhân viêm tụy cấp; Đánh giá giá trị của CRP so với BISAP trong tiên lượng mức độ nặng và hoại tử của viêm tụy cấp. Đối tượng và phương pháp: Nghiên cứu mô tả cắt ngang trên 100 bệnh nhân viêm tụy cấp có theo dõi và điều trị tại Bệnh viện Chợ Rẫy từ tháng 12/2021 đến tháng 8/2022. Kết quả: Nồng độ CRP trung bình lúc vào viện và sau vào viện 48 giờ lần lượt là 231,6 ± 134,9 và 201,1 ± 102,0 (mg/L) (p < 0,001). Điểm BISAP ở nhóm bệnh nhân viêm tụy cấp nặng là 2,11 ± 0,96 và không nặng là 1,1 ± 0,91 (p < 0,001). CRP lúc vào viện (điểm cắt 328) có giá trị tiên lượng viêm tụy cấp nặng và hoại tử đều là 0,72 (p < 0,05). CRP sau vào viện 48 giờ (điểm cắt 210) có giá trị tiên lượng viêm tụy cấp nặng là 0,689 (p = 0,012) và không có giá trị tiên lượng viêm tụy cấp hoại tử. BISAP có giá trị trong tiên lượng mức độ nặng viêm tụy cấp và viêm tụy cấp hoại tử ở mức trung bình với AUC lần lượt là 0,771 (p < 0,001) và 0,742 (p < 0,0001). Kết luận: CRP có giá trị trong tiên lượng mức độ nặng ở bệnh nhân viêm tụy cấp, phù hợp để đánh giá nhanh tình trạng và diễn tiến của bệnh nhằm đưa ra quyết định điều trị phù hợp và kịp thời.
... 4 Lactate dehydrogenase (LDH) is an enzyme that converts pyruvate to lactate when oxygen is in short supply. 5 It is found in almost all body tissue and released during tissue damage. 6 Elevated LDH levels have been observed in conditions such as tissue injury, hypoxia, necrosis, or malignancy. ...
Background and aims
Acute pancreatitis (AP) frequently presents in emergency departments and poses challenges in predicting severity and mortality. Established scoring systems like Ranson criteria, Acute Physiology And Chronic Health Evaluation II (APACHE) II, and Bedside Index of Severity in Acute Pancreatitis (BISAP) have varying effectiveness. Lactate dehydrogenase (LDH), an enzyme released during tissue damage, shows promise as a marker for organ injury in AP. This study aimed to evaluate LDH’s potential to predict mortality risk and hospital stay duration in AP patients.
Methods
A retrospective cohort study analyzed AP cases at HCA Healthcare facilities from January 2011 to January 2021. Among 514 patients with LDH data at admission, groups were categorized based on LDH levels. Outcomes included hospital and ICU stay lengths, mortality rates, and factors such as age, gender, race, BMI, and medical history.
Results
Patients were stratified into three groups: Group 1 (<300 IU/L), Group 2 (300–600 IU/L), and Group 3 (>600 IU/L) based onLDHlevels. Patients withLDH>600 IU/L experienced an average hospital stay extension of 4.5 days,were 3.2 times more likely to require ICU admission, and faced a 12.1 times higher mortality risk compared to those with LDH <300 IU/L.
Conclusion
This study highlights LDH as a potentially valuable predictor of hospital stay duration, ICU requirements, and mortality rates in AP patients. Its cost-effectiveness and accessibility suggest LDH testing could aid clinical decision-making in AP management. Future prospective studies should further explore LDH’s role in optimizing AP patient care.
... With the limited number of indicators being factored in, this score cannot fully capture the clinical condition of AP patients. Therefore, attempts to modify this scoring system to incorporate other factors, such as function of vital organs, nutritional status, and complications, for a more comprehensive assessment are necessary [61][62][63][64][65]. ...
... 4 Its prevalence is 25%. 2 A high % mortality rate of 50% necessitates using an effective laboratory tool to predict the extent at early presentation. 5,6 Multiple clinical and radiological scores to forecast the extent and prognosis have progressed over time. Authentication and comparison of these scores are dwindled by incompatible use of lexicon and classifications in terms of severity, complications, and prognosis of disease. ...
... 5 However, no scoring P PL LR R i in n A Ac cu ut te e B Bi il li ia ar ry y P Pa an nc cr re ea at ti it ti is s Pak Armed Forces Med J 2024; 74(6):1651 system can be used in early phases to detect the extent of disease as they lack sensitivity, have a wide range of sub-parameters, and are time-consuming. 6 Therefore, a consensus among clinicians is needed to devise a simple, efficient, and cost-effective system to improve the mortality and morbidity of this disease. ...
Objective: To establish diagnostic precision regarding platelet-lymphocyte ratio for prophesying the severity of acute biliary pancreatitis in the early diagnostic phase, taking the Computed Tomography Severity Index as the gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Pakistan Air Force Hospital Mushaf Base, Sargodha Pakistan, Jan to Dec 2023. Methodology: Two hundred and twenty-five (n=225) patients diagnosed with acute biliary pancreatitis lying within an age bracket of 18-70 years (male and female) were inculcated. Patients having chronic diseases such as chronic pancreatitis, diabetes mellitus, cardiovascular diseases, end-stage renal and hepatic diseases, and other causes, e.g., Trauma, Endoscopic Retrograde Cholangiopancreatography, (iatrogenic), hypertriglyceridemia, and alcohol, were excluded. All patients were treated for acute pancreatitis. Seventy-two hours after admission, all patients underwent a Computed Tomography scan for Computed Tomography Severity Index. Results: Platelet-lymphocyte ratio supported the diagnosis of severe acute pancreatitis in 99(44.0%) patients. Computed Tomography Severity Index findings confirmed severe acute pancreatitis in 93(41.33%) cases. In patients having platelet-lymphocyte ratio positive, 83 were TP, and 16 were FP. In 126 platelet-lymphocyte ratio-negative patients, 10 were FN, and 116 were TN (p=0.0001). Overall sensitivity was 89.25%, specificity was 87.88%, Positive and negative predictive values were 83.84% and 92.06% Conclusion: The diagnostic precision of platelet-lymphocyte ratio in forecasting the extent of acute biliary pancreatitis during the early diagnostic stage is quite high.
... The BISAP score has proven useful in mortality prognostication for AP patients with a meta-analysis by Gao et al [9] showing BISAPs >3 having a 56% (95% CI = 53%-60%) risk for mortality with 91% specificity. Our study population also showed this positive and significant association between BISAP and mortality as well as LOS. ...
Background
Acute kidney injury (AKI) is a common complication in acute pancreatitis (AP), with a significant impact on mortality. The Bedside Index for Severity in Acute Pancreatitis (BISAP) score is well-established for assessing mortality risk in AP, but its utility in predicting AKI is less explored.
Methods
We conducted a retrospective chart review of 779 AP patients across two hospitals in New York, USA, from 2016 to 2022. Data on patient demographics, laboratory values, and vital signs were collected. BISAP scores were calculated. The primary outcome was AKI, defined by the KDIGO criteria. Multivariate logistic regression was done to assess the association between the BISAP score and AKI, adjusting for confounders. Secondary outcomes include the association of the BISAP score to hospital length of stay and mortality.
Results
There was a significant association between the BISAP score and AKI, with an odds ratio of 2.36 [95% C.I 1.42-4.41, p =0.001], indicating a more than twofold increase in AKI risk for each point increase in BISAP score. The BISAP score was also significantly correlated with longer hospital stays and increased mortality risk.
Conclusion
The BISAP score is a strong predictor of AKI in AP patients. This association and relation to hospital stay and mortality highlights the potential of the BISAP score as a comprehensive risk assessment tool in AP, especially for early identification of patients at high risk for AKI. This study paves the way for future research into risk scoring systems for AKI in AP based on significant BISAP components.
