A Comparative Study of Bedside Index for Severity in Acute Pancreatitis (BISAP) and Acute Physiology and Chronic Health Evaluation II (Apache II) Score in Assessing the Severity of Acute Pancreatitis

Abstract

Background: Acute pancreatitis is a common gastrointestinal disorder with substantial burden on the healthcare system. Since 1974, various scores have been developed using clinical and radiological parameters to assess the severity of acute pancreatitis. BISAP and APACHE II score have been developed for evaluation and to assess the severity of patients with acute pancreatitis. To evaluate BISAP and APACHE II score of patients with acute pancreatitis, compare sensitivity and specificity of BISAP and APACHE II score and to see predictive accuracy of BISAP and APACHE II score to analyse severity in acute pancreatitis. Material & Methods: The study was conducted in the department of General Surgery, GGS Medical College and Hospital, Faridkot, on 40 diagnosed patients of acute pancreatitis. Results: The ROC analysis for organ failure showed BISAP score has AUC of 0.927, sensitivity of 100%, specificity of 75%, PPV of 30%, NPV 100% and diagnostic accuracy of 77.5%; whereas APACHE II score has AUC 0.983, sensitivity of 100%, specificity of 94.4%, PPV of 66.6%, NPV of 100% and diagnostic accuracy of 95%. The ROC analysis for pancreatic necrosis showed BISAP score has AUC of 0.882, sensitivity of 100%, specificity of 75%, PPV of 30.7%, NPV 100% and diagnostic accuracy of 77.5%; whereas APACHE II score has AUC 0.924, sensitivity of 100%, specificity of 77.7%, PPV of 33.3%, NPV of 100% and diagnostic accuracy of 80%. The ROC analysis for prediction of mortality has AUC (0.730, 0.735), sensitivity (66.6, 66.6%), specificity (73.53%, 79.41%), PPV (30.7%,33.6%), NPV(92.59%,93.1%)and diagnostic accuracy(72.5%, 77.5%), for BISAP and APACHEII scores, respectively. Conclusion: BISAP score was found to have sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy as close to APACHE II score in predicting the severity of acute pancreatitis. Even though APACHE II score is stronger to predict organ failure than BISAP but BISAP being simple, easy to calculate, economical and reliable can be used as preliminary tool to stratify patients and to manage accordingly for better outcome. Hence, using BISAP score, patients having probability of progressing to severe disease can be assessed early.