Bedside index for severity in acute pancreatitis:comparison with other scoring systems in predicting severity and organ failure

摘要

BACKGROUND: The  early  identification  of  severe  acute pancreatitis is important for the management and for improving outcomes. The bedside index for severity in acute pancreatitis (BISAP)  has  been  considered  as  an  accurate  method  for  risk stratification  in  patients  with  acute  pancreatitis.  This  study aimed to evaluate the comparative usefulness of the BISAP. METHODS: We  retrospectively  analyzed  303  patients  with acute pancreatitis diagnosed at our hospital from March 2007 to  December  2010.  BISAP,  APACHE-II,  Ranson  criteria,  and CT  severity  index  (CTSI)  of  all  patients  were  calculated.  We stratified  the  number  of  patiants  with  severe  pancreatitis, pancreatic  necrosis,  and  organ  failure  as  well  as  the  number of deaths by BISAP score. We used the area under the receiver-operating  curve  (AUC)  to  compare  BISAP  with  other  scoring systems,  C-reactive  protein  (CRP),  hematocrit,  and  body mass  index  (BMI)  with  regard  to  prediction  of  severe  acute pancreatitis, necrosis, organ failure, and death. RESULTS: Of  the  303  patiants,  31  (10.2%)  were  classified  as having severe acute pancreatitis. Organ failure occurred in 23 (7.6%) patients, pancreatic necrosis in 40 (13.2%), and death in 6 (2.0%). A BISAP score of 2 was a statistically significant cutoff value for the diagnosis of severe acute pancreatitis, organ failure, and mortality. AUCs for BISAP predicting severe pancreatitis and death were 0.80 and 0.86, respectively, which were similar to those for APACHE-II (0.80, 0.87) and Ranson criteria (0.74, 0.74) and greater than AUCs for CTSI (0.67, 0.42). The AUC for organ failure predicted by BISAP, APACHE-II, Ranson criteria, and CTSI was 0.93, 0.95, 0.84 and 0.57, respectively. AUCs for BISAP predicting severity, organ failure, and death were greater than those for CRP (0.69, 0.80, 0.72), hematocrit (0.45, 0.35, 0.14), and BMI (0.41, 0.47, 0.17). CONCLUSION: The BISAP predicts severity, death, and especially organ failure in acute pancreatitis as well as APACHE-II does and better than Ranson criteria, CTSI, CRP, hematocrit, and BMI.