Role of bedside pancreatic scores and C-reactive protein in predicting pancreatic fluid collections and necrosis.

Abstract

Acute pancreatitis is a disease with variable outcome; the course of the disease can be modified by early aggressive management in patients with severe pancreatitis. Easily calculable pancreatic scores and investigations can help to triage these patients. We aimed to determine the role of bedside index for severity in acute pancreatitis (BISAP), harmless acute pancreatitis score (HAPS), and systemic inflammatory response syndrome (SIRS) scores on day of admission and C-reactive protein (CRP) at 48h for predicting the presence of pancreatic fluid collection (PFC) and necrosis on CT scans done at 72h. Of a total of 114 consecutively seen patients of pancreatitis, 64 with acute pancreatitis were enrolled in the study. All individuals had the pancreatitis predicting scores calculated at the time of admission, CRP at 48h, and contrast-enhanced computed tomography (CECT) abdomen at 72h from admission. The study population of 64 (55 male) had a mean (+SD) age of 37.7±13years. Alcohol was the most common (68.8%) etiology in these patients. Based on CECT, patients were divided into 2 groups; group 1 with 41 patients who had mild pancreatitis and group 2 with 23 patients who had pancreatic fluid collection with or without necrosis (PFCN). PFCN were seen in 19 (29.7%) of patients with 2 or more SIRS criteria, 17 (26.6%) of patients with BISAP score ≥3, and 16 patients (25.0%) with HAPS >0 respectively. All three scores were able to predict PFCN significantly. CRP >150mg/L was noted in 23 patients and was able to predict the presence of fluid collections (p=0.0002) and pancreatic necrosis (p=0.0004) on CT. BISAP, HAPS, and SIRS scores and CRP of 150mg/L all correlated significantly with the occurrence of fluid collections and pancreatic necrosis on CT at 72h. None of the scores was superior to the other in this respect.