Evaluation of the severity of acute pancreatitis using BISAP, Ranson and APACHE II scores and comparing them with Modified Computed Tomography Severity Index score
Abstract
Aims and Objectives: Most of the studies published so far compare one or two out of the three clinical scores for assessing the severity of acute pancreatitis namely BISAP, Ranson and APACHE II scores with the Radiological Score of Modified Computed Tomography Severity Index. There is a paucity of studies that compare all three Clinical Scores with the Radiological Score of Modified Computed Tomography Severity Index. The aim of this study is to compare all three clinical scores with the radiological score mentioned above.
Materials and Methods: This is a cross sectional study which was conducted in the Department of Medicine and Department of Radiology, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi. A total of 40 patients were studied from November 2018 to March 2020. Admitted patients who fit into the New Diagnostic Criteria of the Revised Atlanta Classification for acute pancreatitis were taken into the study after getting the informed consent signed. CECT abdomen was done during the hospital stay and modified CTSI score was calculated. Patients with BISAP score ≥ 3, Ranson score ≥ 3, APACHE II score ≥ 8 and modified CTSI ≥ 4 (4-6: moderately severe, 8-10: severe; Note that in modified CTSI score, the final scores are always in even number) were classified as severe acute pancreatitis.
Results: The results of our study showed that the Modified CTSI score has the highest accuracy among the four scores in predicting severity of acute pancreatitis (AUC 0.969, P value <0.0001) which is statistically significant. Among the bedside scores namely APACHE II, Ranson and BISAP scores, the AUC was high in APACHE II score (AUC 0.750, P value 0.001) in comparison with Ranson score (AUC 0.688, P value <0.0001) and BISAP score (AUC 0.656, P value 0.0002).
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Introduction
The global incidence of acute pancreatitis is 33.74 per 100,000 population per year and the crude mortality rate is 1.16 per 100,000 population per year[1] with the mortality rate of about 3% overall[2], 10-30% in severe pancreatitis[3] .
There are several scoring systems to categorise the severity of acute pancreatitis. The patients with mild acute pancreatitis can be managed conservatively. Whereas patients with severe acute pancreatitis need intensive medical care and may require respiratory assistance, hemodialysis and inotropic support for hemodynamic stability. There are four widely used scoring systems based on lab investigations, clinical and radiological findings. They are BISAP score (Bedside Index of Severity in Acute Pancreatitis), APACHE II score (Acute Physiology And Chronic Health Evaluation), Ranson score and Modified CTSI Score (Computed Tomography Severity Index) which includes Balthazar CTSI score and Necrosis score based on CECT abdomen.
Conclusion
The mortality rate in our study was 22.50%. According to Revised Atlanta classification of acute pancreatitis, 32.50% of the study population belonged to moderately severe category and 47.50% of the study population belonged to severe category in our study.