Effect of adjuvant treatment on recurrence of intraductal papillary mucinous neoplasm with an associated invasive carcinoma after operation

Abstract

s / Pancreatolog e44 Aim: The aim of this study was to evaluate the usefulness of the Bedside Index for Severity in Acute Pancreatitis (BISAP) in the early prediction of severity and mortality in AP in a non-Western area. Methods: The medical records of all patients with AP admitted to our institution between January 2008 and July 2010 were reviewed retrospectively. Severe AP (SAP) was defined as the persistence of organ failure for more than 48 h. The BISAP and Ranson's score were calculated using data from 24 and 48 h after admission, respectively. The capacity of the BISAP score to predict severity and death was evaluated using linear-bylinear association. The predictive accuracy of the BISAP and Ranson's score was measured as the area under the receiver-operating characteristic curve (AUC). Results: Of 299 consecutive patients, 22 (7.4%) were classified as having SAP. There were eight (2.7%) deaths, all in SAP patients (36.4%). There were statistically significant trends for increasing severity (P < 0.001) and mortality (P < 0.001) with increasing BISAP. The AUC for severity predicted by BISAP was 0.762 (95% confidence interval [CI]: 0.631–0.893) and by Ranson's score was 0.804 (95% CI: 0.717–0.892). The AUC for mortality predicted by BISAP was 0.940 (95% CI: 0.863– 1.018) and by Ranson's score was 0.861 (95% CI: 0.734–0.988). A BISAP of 3 was associated with a very highly increased risk of SAP (odds ratio [OR] 1⁄4 76.1, 95% CI: 18.5–312.9) and death (OR 1⁄4 121.7, 95% CI: 20.8–712.6). A Ranson's score of 3 was also associated with an increased risk of SAP (OR 1⁄4 6.5, 95% CI: 2.1–19.7) and death (OR 1⁄4 9.4, 95% CI: 1.1–77.2). Conclusion: We confirmed that BISAP is an accurate means of risk stratification in patients with AP within 24 h of presentation.