BISAP-eGFR could improve prediction of severity and mortality in acute pancreatitis. eGFR ? play the trump card.

Abstract

Introduction: Early prediction of severity of acute pancreatitis (AP) by a simple system which includes clinical features would be very helpful as it may direct management and improve outcome. Certain components of different scores reflecting severe intravascular volume depletion can play an important role in accuracy of the method (but sensitivity and specificity of these scores are not at the desired level yet). Low eGFR (estimated glomerular filtration rate) is already known to be unfavorable prognostic parameter in AP, however it was never assessed as an element of multifactor score. Aim: The aim of this study is to determine whether replacing urea nitrogen (BUN) in bedside index of severity in acute pancreatitis (BISAP) score by eGFR (BISAP-eGFR score) improves prediction of severity and mortality in patients with AP. Methods: Cohort of 100 patients with AP were prospectively enrolled in the study. The BISAP and eGFR (abbreviated Modification of Diet in Renal Disease equation) were calculated using data from the first 24 h from admission. Severe AP was defined as the persistence of organ failure exceeding 48 hours. The predictive accuracy of the BISAP and BISAP-eGFR score was measured as the area under the receiver operating characteristic curve (AUC). Results: We evaluated a total of 100 consecutive patients with AP. Twenty of the 100 patients (20%) were considered severe AP. The best cutoff value of eGFR was 80 ml/min/1,73 m2. All 20 patients with severe pancreatitis had eGFR 25 mg/dL (BISAP score cut-off for BUN). Overall, 16% of the 100 evaluated patients had a BISAP score ≥3 while BISAP-eGFR score ≥ 3 was reported for 23% patients. A BISAP score ≥ 3 had a sensitivity, specificity, positive and negative predictive value of 65%, 96.1%, 81.2% and 91.3% respectively, with an accuracy of 87% comparing to 95.2%, 96.2%, 86.9% and 98.7% respectively for BISAP-eGFR score with an accuracy of 96%. The AUC for severity predicted by BISAP was 0.762 and by BISAP-eGFR score was 0.942. There were statistically significant trends for increasing severity (P<0.001) and mortality (P<0.001) with increasing BISAPeGFR score. Ten out of ten (100%) patients with fatal AP had BISAP-eGFR ≥3, 6 of them (60%) reported BISAP≥3. Conclusion: BISAP-eGFR score is a simple method to identify patients at risk of increased mortality and allows predicting the severity of the AP. eGFR replacing BUN in BISAP score provides higher sensitivity, specificity and diagnostic accuracy comparing to traditional BISAP score. In addition, eGFR component may be helpful in planning fluid therapy, particularly in the acute phase of the AP. This finding may have important clinical implications, however further studies are required to validate the BISAPeGFR score in predicting severity and mortality in AP.