A Prospective Study to Evaluate BISAP Score in Acute Pancreatitis

Abstract

Introduction: Acute Pancreatitis (AP) is among leading cause of acute abdomen in the study institution. There is a need of simple criteria to stratify patients in Emergency Department. The Bedside Index for Severity in Acute Pancreatitis (BISAP) score is one such score. Aim: This study evaluates the BISAP score to predict organ failure, pancreatic necrosis and moderately severe/severe AP in tertiary health care center in India and promote its use. Materials and Methods: This prospective observational study was conducted on 50 consecutive patients diagnosed as AP from May 2019 to April 2020 and admitted in Emergency Department of DMC Hospital, Ludhiana, India. BISAP score was calculated based on data obtained within 24 hours of hospitalisation. Severity of AP was defined according to the Revised Atlanta Classification, 2012. Organ failure was defined using the Modified Marshall scoring system. Data was expressed in terms of median, frequencies (number of cases) and relative frequencies (percentages); range; mean±Standard Deviation (±SD). All statistical calculations were done in Microsoft Windows Statistical Package for the Social Science (SPSS) version 21.0. Results: The leading cause of AP in present study is gall stones, with maximum 26 (52%) cases. Second most common cause is alcohol with 11 (22%) cases. Systemic Inflammatory Response Syndrome (SIRS) is the most common component of BISAP score, present in 47 (94%) cases. Pancreatic necrosis present in 12 (24%) cases. Incidence of pancreatic necrosis rises at score ≥3 which is statistically significant (p-value- 0.008). Transient organ failure was present in 14 (28%) cases, persistent organ failure was present in 9 (18%) cases and 27 (54%) cases had no organ failure. At score ≥3, there is increased risk of organ failure and it is statistically significant (p-value ≤0.001). There are 27 (54%) mild, 14 (28%) moderately severe and 9 (18%) severe cases of AP. At score ≥3, there is increased risk of moderately severe and severe pancreatitis and it is statistically significant (p-value ≤0.001). Conclusion: There is statistically significant trend of increasing incidence of organ failure, pancreatic necrosis and moderately severe/severe AP at BISAP score ≥3. Thus, BISAP score is simple yet accurate scoring system to improve early risk stratification in AP.

Keywords

• gall stones
• new scoring method
• organ failure
• pancreatic necrosis
• tertiary care centre