BISAP score and procalcitonin versus APACHE II score and C-reactive protein in early assessment of the severity and outcome of acute pancreatitis

Abstract

Aims/objectives: Early assessment of the severity and continuous patients monitoring are key factors for the adequate treatment of acute pancreatitis (AP). The objective was to determine the value of BISAP score and procalcitonin (PCT) as prognostic markers in early stages of AP with comparison to “Acute physiology and chronic health evaluation” (APACHE II) score and C-reactive protein (CRP). Patients and methods: Prospective study included 51 patients (29 with severe AP). In the first 24 h of admission the APACHE II and BISAP score, CRP and PCT serum concentrations were determined. The values of PCT serum concentrations and BISAP score were compared with values of CRP serum concentrations and APACHE II score, in relation to disease severity and outcome. Results: Values of PCT, CRP, BISAP score and APACHE II score were significantly elevated in patients with severe AP. In predicting the severity of AP at 24 h of admission, sensitivity and specificity of BISAP score were (74%; 59%), APACHE II score (89%; 69%), CRP (75%; 86%) and PCT (86%; 63%). The strength to predict severe AP with accuracy, APACHE II score was significantly stronger than BISAP score (Z1⁄42.738, p1⁄40.006). PCT was significantly elevated in patients with fatal outcome (p<0,001). Conclusion: In early prediction of AP severity, PCT has better predictive value than CRP, and similar to APACHE II score. PCT is better predictor of fatal outcome than CRP, BISAP score and APACHE II score. APACHE II score is a better predictor of disease severity than BISAP score, but similar to BISAP score in prediction of fatal outcome.