COMPARISON OF BISAP, NLR AND HAPS IN PREDICTING SEVERITY OF ACUTE PANCREATITIS, ACCORDING TO THE 2012 REVISION OF ATLANTA CLASSIFICATION

Abstract

Backgrond. Early risk stratification is crucial in Acute Pancreatitis (AP). The BedSide Index for Severity in Acute Pancreatitis (BISAP) allows risk stratification at the time of hospital admission through a five-variable analysis. Several inflammatory markers have shown prognostic value in AP. Amongst them the Neutrophil to Lymphocyte Ratio has the best predictive accuracy. The Harmless Acute Pancreatitis Score (HAPS) is used to predict mild AP. Our objective was to compare BISAP, NLR and HAPS as predictors of severity in acute pancreatitis. Material and Methods. A six-year (January 2014 – December 2019) retrospective analysis of a prospective database of all the patients admitted with the diagnosis of AP. Included variables: age, sex, BISAP score, NLR, HAPS score, length of stay, severity and mortality. Severity was defined according to 2012 revision of Atlanta classification. Accuracy of prediction was measured by the area under the receiver operating characteristic curve (AUC). Positive Predictive Value (PPV), Negative Predictive Value (NPV), Sensitivity and Specificity were also calculated. Results. Total of 284 cases; 121 male and 163 female; median age was 71 years [21 – 95]. 216 patients presented mild AP, 34 moderate and 34 severe AP; overall mortality was 4.2%. The BISAP AUC for prediction of severity was 0,86 [0,796 – 0,936]. Sensivity was 44.1% and specificity was 93.2%. PPV was 68.2% and NPV was 92.8%. The NLR AUC was 0,7 [0,607 – 0,798]. Sensivity was 78.8% and specificity was 51.8%. PPV was 78.8% and NPV was 94.8%. Finally, HAPS AUC for prediction of mild AP was 0,706 [0,623 – 0,790]. Sensitivity was 60.6% and specificity was 72.1%. PPV was 87.3% and NPV was 36.6%. Conclusion. BISAP, NLR and HAPS are valuable tools for an early risk stratification and prognosis evaluation in AP. The best calculated accuracy for the prediction of severity was for BISAP.