Comparison of BISAP and Ranson’s score for predicting severe acute pancreatitis and establish the validity of BISAP score
DOI:
https://doi.org/10.18203/2349-2902.isj20201854Keywords:
BISAP score, Ranson’s score, Revised Atlanta classification, Severe acute pancreatitisAbstract
Background: Pancreatitis can lead to serious complications with severe morbidity and mortality. So an early, quick and accurate scoring system is necessary to stratify the patients according to their severity so as to enable early initiation of required management and care. Scoring system commonly used have some drawbacks. This study aimed to compare bedside index for severity in acute pancreatitis (BISAP) and Ranson’s score to predict severe acute pancreatitis and establish the validity of a simple and accurate clinical scoring system for stratifying patients.
Methods: This is a prospective comparative study on 100 patients diagnosed with acute pancreatitis admitted in department of general surgery. Parameters included in the BISAP and Ranson’s criteria were studied at the time of admission and after 48 hours. Result of these two were compared with that of revised Atlanta classification.
Results: As per the BISAP score, the sensitivity and specificity were 95.8 % (95% CI, 76.8-99.8), 94.7 % (95% CI, 86.3-98.3) whereas positive likelihood ratio, negative likelihood ratio 18.21 (95% CI, 6.9-47.44), 0.04 (95% CI, 0.01-0.30) and accuracy was 95 % (95% CI, 88.72%-98.36%). On using Ranson’s score, the sensitivity and specificity were 91.6 (95% CI, 71.5-98.5) and 89.4 (95% CI, 79.8-95) with a positive predictive value 8.71 (95% CI, 4.47-18.96) and negative predictive value of 0.09 (95% CI, 0.02-0.35) and accuracy of 90% (95% CI, 82.38%-95.10%)..
Conclusions: BISAP score outperformed Ranson’s score in terms of Sensitivity and specificity of prediction of severe pancreatitis. The authors recommend inclusion of BISAP Scoring system in standard treatment protocol of management of acute pancreatitis.
References
British Society of Gastroenterology. United Kingdom guidelines for the management of acute pancreatitis. Gut. 1998;42(2):1-13.
Dervenis C, Johnson CD, Bassi CA, Bradley E, Imrie CW, McMahon MJ, et al. Diagnosis, objective assessment of severity,and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol. 1999;25:195-210.
Wig JD, Bharathy KG, Kochhar R, Yadav TD, Kudari AK, Doley RP, et al. Correlates of organ failure in severe acute pancreatitis. JOP. 2009;10:271‑5.
Gloor B, Müller CA, Worni M, Martignoni ME, Uhl W, Büchler MW. Late mortality in patients with severe acute pancreatitis. Br J Surg Society. 2001;88(7):975-9.
Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence‑based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4):1‑15.
Fagenholz PJ, Fernández-Del Castillo C, Harris NS, Pelletier AJ, Camargo Jr CA. Increasing United States hospital admissions for acute pancreatitis,1988-2003. Ann Epidermiol. 2007;17:491-7.
Banks PA, Freeman ML, Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379-400.
Ranson JHC, Rifkind KM, Roses DF, SD F. Prognostic signs and the role of Operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139:69‐81.
Ranson JHC. Etiological and prognostic factors in human acute pancreatitis: A review. Am J Gastroenterol.1982:77:633.
Yeung YP, Lam BY, Yip AW. APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis. Hepatobiliarypancreat Dis Int. 2006;5:294-9.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system, Critical Care Med. 1985;13(10):818-29.
Taylor SL, Morgan DL, Denson KD, Lane MM, L. Pennington R. A comparison of the Ranson, Glasgow, and APACHE II scoring systems to a multiple organ system score in predicting patient outcome in pancreatitis, Am J Surg. 2005;189(2):219-22.
Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 2012;262(3):751-64.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.
Choi JH, Kim MH, Oh D, Paik WH, Park DH, Lee SS, et al. Clinical relevance of the revised Atlanta classification focusing on severity stratification system. Pancreatology. 2014;14:324-9.
Bollen T L. Imaging of acute pancreatitis: update of the revised Atlanta classification. Radiol Clin North Am. 2012;50(3):429-45.
Sheu Y, Furlan A, Almusa O, Papachristou G, Bae KT. The revised Atlanta classification for acute pancreatitis: a CT imaging guide for radiologists. Emerg Radiol 2012;19(3):237-43.
Zaheer A, Singh VK, Qureshi RO, Fishman EK. The revised Atlanta Classification for acute pancreatitis: Updates in imaging terminology and guidelines. Abdom Imaging. 2013;38:125‑36.
Manrai M, Kochhar R, Thandassery RB, Alfadda AA, Sinha SK. The Revised Atlanta Classification of Acute Pancreatitis: A Work Still in Progress? JOP. 2015;16:356‑64.
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(12):1698-703.
Chen L, Lu G, Zhou Q, Zhan Q. Evaluation of the BISAP score in predicting severity and prognoses of acute pancreatitis in Chinese patients. Inte Surg. 2013;98(1):6-12.
Gao W, Yang HX, Ma CE. The value of BISAP score for predicting mortality and severity in acute pancreatitis: a systematic review and meta-analysis. PloS one. 2015;10(6).
Yadav J, Yadav SK, Kumar S, Baxla RG, Sinha DK, Bodra P, et al. Predicting morbidity and mortality in acute pancreatitis in an Indian population: a comparative study of the BISAP score, Ranson’s score and CT severity index. Gastroenterol Report. 2016;4(3):216-20.
Kaya E, Dervişoğlu A, Polat C. Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis. World J Gastroenterol. WJG. 2007;13(22):3090.
Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A, 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(2):435-41.
Bhopal FG, Azhar F, Mahmood S, Mehmood N, Iqbal M. Validity of Ranson's Criteria in Acute Pancreatitis. J Rawalpindi Med Col. 2011;15(2):84-7.
