Abstract

A Comparative Study between Bedside Index for Severity in Acute Pancreatitis (BISAP) and Acute Physiology and Chronic Health Evaluation (APACHE-II) Scoring System in Assessing the Severity of Acute Pancreatitis at Bangalore Medical College and Research Institute, Bangalore, India

Author(s): Akhila Nallur Theerthegowda1, Pavithra Umashankar2, Nagashri Suresh Iyer3

BACKGROUND
Acute pancreatitis (AP) is an inflammatory disease of the pancreas, that results
from intrapancreatic activation, release, and digestion of the organ by its own
enzymes. The diagnosis of acute pancreatitis can be made when a patient presents
with threefold elevated serum levels of amylase or lipase, abdominal pain and
vomiting. In this study, we wanted to assess the severity of acute pancreatitis by
using BISAP (Bedside index for severity in acute pancreatitis) and APACHE-II
(Acute physiology and chronic health evaluation) scoring systems and compare
the accuracy of BISAP scores with APACHE-II scores.
METHODS
A prospective study including 201 patients was conducted from April 2018 to March
2020 in Victoria Hospital, affiliated to BMCRI.
RESULTS
Among 201 AP patients, 129 were found to have mild acute pancreatitis (MAP),
72 were of severe acute pancreatitis (SAP), 192 survival cases, and 9 death cases.
The larger the rating score, the higher the proportion of severe pancreatitis and
mortality risk. Two kinds of scoring criteria; BISAP score points and Apache II
score points compared in patients with MAP and SAP, In Apache II score to predict
severity of organ failure, the sensitivity, specificity, positive predictive value,
negative predictive value was 84.72 %, 93.02 %, 87.14 %, 91.60 % and area
under the curve was 0.958 (P < 0.0001). In BISAP, the sensitivity, specificity,
positive predictive value, negative predictive value was 90.28 %, 80.62 %, 72.22
%, 93.69 % and area under the curve was 0.917 (P < 0.0001).
CONCLUSIONS
Ability of APACHE II score prediction of AP in severity of organ failure and mortality
are stronger than BISAP score, But APACHE II scoring system indicators were
cumbersome, complicated assessment. BISAP scoring system is simple,
economical, rapid and reliable, and it can effectively predict the severity and
mortality of acute pancreatitis, and can be used as a preliminary screening method
in accurate risk stratification and initiation of management accordingly at
community health care, secondary health care and tertiary health care Hospitals.