Bedside Index For Severity In Acute Pancreatitis Score Research Articles

Use of proton pump inhibitors improves outcomes in mild acute pancreatitis: A nationwide cohort study.

Previous studies showed a potential anti-inflammatory effect of proton pump inhibitors (PPI) as well as possible inhibition of pancreatic secretion. This presents the question of their possible use in acute pancreatitis (AP). Current clinical evidence does not address the role of PPI and the present review for possible therapeutic use and safety is lacking. Therefore, our study aims to address the role of PPI in the management of AP and their association with the different outcomes of AP. We queried the Diamond Network through TriNetX-Research Network. This network included 92 healthcare organizations. Patients with mild AP with Bedside Index of Severity in Acute Pancreatitis (BISAP) score of Zero regardless of etiology were divided into 2 cohorts; 1st cohort included patients on PPI, and 2nd cohort included patients not on any PPI. Patients with BISAP score equal to or more than 1 or on PPI prior to the study date were excluded. Two well-matched cohorts were created using 1:1 propensity-scored matching model between cohorts. We compared the incidence of intensive care unit admission, mortality, and other associated complications. A total of 431,571 patients met the inclusion criteria. Of those, 32.9% (n = 142,062) were on PPI, and 67% (n = 289,509) were not on any PPI. After propensity matching, the sample included 115,630 patients on PPI vs 115,630 patients not on PPI. The PPI group had a lower rate of mortality (3.7% vs 4.4%, P < .001), a lower rate of intensive care unit admission (3.9% vs 5.5%, P < .001), a lower rate of necrotizing pancreatitis (1.1% vs 1.9%, P < .001), a lower rate of Hospital-Acquired Pneumonia (3.6% vs 4.9%, P < .001), a lower rate of respiratory failure (2.8% vs 4.2%, P < .001), and a lower rate of acute kidney injury (6.9% vs 10.1%, P < .001). There was no statistical difference in the rate of Clostridium difficile infection between the 2 cohorts (0.9% vs 0.8%, P = .5). The use of PPI in mild AP with a BISAP-score of zero is associated with reduced pancreatitis-related complications and improved mortality. Prospective studies are needed to confirm these findings.

B Cells and Double-Negative B Cells (CD27-IgD-) Are Related to Acute Pancreatitis Severity.

Acute pancreatitis (AP) is an increasingly frequent disease in which inflammation plays a crucial role. Fifty patients hospitalized with AP were included and peripheral blood samples were analyzed for B and T cell subpopulations at the time of hospitalization and 48 h after diagnosis. The Bedside Index of Severity in Acute Pancreatitis (BISAP) and length of hospital stay were also recorded. A healthy control (HC) group of 15 outpatients was included. AP patients showed higher neutrophil/lymphocyte (N/L) ratios and higher percentages of B cells than the HC group. The total B cell percentages were higher in patients with moderate/severe AP than in patients with mild AP. The percentages of B cells as well as the percentages of the CD27-IgD- B cell subset decreased from admission to 48 h after admission. The patients with higher BISAP scores showed lower percentages of peripheral lymphocytes but higher percentages of CD27-IgD- B cells. Higher BISAP scores, N/L ratios, and peripheral blood B cell levels emerged as predictors of hospital stay length in AP patients. Our findings underscore the importance of early markers for disease severity. Additionally, the N/L ratio along with the BISAP score and circulating B cell levels form a robust predictive model for hospital stay duration of AP patients.

Interleukin-6 Concentration in Early Assessment of Severity and Prediction of Outcome among Patients with Acute Pancreatitis: A Prospective Cohort Study

Introduction: Various inflammatory markers, such as C-reactive Protein (CRP), Interleukin (IL), and Tumour Necrosis Factor (TNF), are used as indicators of illness severity in acute pancreatitis. Concentrations of inflammatory mediators are correlated to the severity of the disease. If detected before the occurrence of multiple organ dysfunction, early initiation of aggressive therapy might prevent its development. IL-6, released by macrophages in response to tissue injury, peaks 24 hours after the onset of inflammation and can be used to predict early disease severity. The Bedside Index of Severity in Acute Pancreatitis (BISAP) scoring system was used to assess the severity of acute pancreatitis. Aim: To study the association of IL-6 levels with the BISAP in predicting the outcome. Materials and Methods: A prospective cohort study was conducted in the Department of General Surgery at Government Medical College, Kottayam, Kerala, India. The duration of the study was 12 months, from January 1, 2019 to December 31, 2019. The study was done on patients of either gender, aged between 18 and 60 years, with clinical features suggestive of acute pancreatitis. After obtaining informed consent, a 4 mL venous blood sample was taken, and serum amylase and serum lipase levels were estimated. If serum amylase/lipase levels were three times above the normal range, a diagnosis of acute pancreatitis was made according to revised Atlanta criteria. Meanwhile, the BISAP score was calculated. After reaching a sample size of 77 for the present study, IL-6 estimation was performed using an Enzyme-linked Immunoassay (ELISA) kit. At the end of the study, IL-6 concentration was compared with the BISAP score to assess severe acute pancreatitis. The data entered in Microsoft Excel were analysed using the Chi-square test and Fisher’s-exact test. Results: The mean age of the study participants was 30 years, with 37 patients (48%) between the ages of 20-40 years and 40 patients (52%) between the ages of 40-60 years. Out of the 77 study subjects, 71 were males and six were females. There was a significant association between Intensive Care Unit (ICU) admission with persistent organ failure, which indicates severe acute pancreatitis. Conclusion: In the present study, no significant association was found between IL-6 and the BISAP score in the early assessment and prediction of the severity of acute pancreatitis.

[Construction of prediction model of severe acute pancreatitis based on serum soluble T cell immunogloblulin and mucin domain-containing protein 3].

To investigate the predictive value of the model based on soluble T cell immunogloblulin and mucin domain-containing protein 3 (sTIM3) for the progression of severe acute pancreatitis (SAP) in patients with acute pancreatitis (AP). A retrospective cohort study was conducted. The AP patients admitted to Changzhou First People's Hospital and Changzhou Second People's Hospital from June 1, 2020 to June 30, 2022 were enrolled. Mild AP (MAP) and moderately severe AP (MSAP) patients were classified as non-SAP group, and SAP patients were classified as SAP group according to the progression of AP patients during hospitalization. The basic data, blood biological indicators, serum sTIM3 level, bedside index for severity in acute pancreatitis (BISAP), acute physiology and chronic health evaluation II (APACHE II) score, modified computed tomography severity index (MCTSI) score within 48 hours of admission, and prognosis indicators were collected. Multivariate Logistic regression analysis was conducted to analyze the risk factors of the progression of SAP in patients with AP during hospitalization. Based on the results of multivariate analysis and the best parameters selected based on the minimal Akaike information criterion (AIC), the SAP prediction model based on sTIM3 was constructed. The receive operator characteristic curve (ROC curve) was plotted to analyze the predictive efficacy of the model. A total of 99 AP patients were enrolled, 80 patients in the non-SAP group and 19 patients in the SAP group. Compared with the non-SAP group, body mass index (BMI), drinking history ratio, heart rate (HR), respiration rate (RR), white blood cell count (WBC), red blood cell count (RBC), C-reactive protein (CRP), alanine aminotransferase (ALT), serum creatinine (SCr), procalcitonin (PCT), interleukin-6 (IL-6), sTIM3, BISAP score, APACHE II score and MCTSI score were significantly increased, and pulse oxygen saturation (SpO2), direct bilirubin (DBil) and IL-10 were significantly decreased. The length of intensive care unit (ICU) stay and total length of hospital stay of patients in the SAP group were significantly longer than those in the non-SAP group [length of ICU stay (days): 1.0 (0, 1.5) vs. 0 (0, 0), total length of hospital stay (days): 17.11±9.39 vs. 8.40±3.08, both P < 0.01]. Multivariate Logistic regression analysis showed that HR [odds ratio (OR) = 1.059, 95% confidence interval (95%CI) was 1.010-1.110, P = 0.017], DBil (OR = 0.981, 95%CI was 0.950-0.997, P = 0.043), and sTIM3 (OR = 1.002, 95%CI was 1.001-1.003, P = 0.027) were independent risk factors for predicting the progression of SAP in patients with AP, and the SAP prediction model based on sTIM3 was constructed: Logit(P) = -14.602+0.187×BMI+0.057×HR+0.006×CRP-0.020×DBil+0.002×sTIM3. ROC curve analysis showed that among the aforementioned single factor quantitative indicators, IL-6 was the most effective in predicting the progression of AP patients to SAP during hospitalization, but the predictive performance of prediction model based on the sTIM3 was significantly better than IL-6 [area under the ROC curve (AUC) and 95%CI: 0.957 (0.913-1.000) vs. 0.902 (0.845-0.958), P < 0.05]. The model based on serum sTIM3 demonstrated good predictive value for the progression of SAP in patients with AP.

Red cell distribution width: A predictor of the severity of hypertriglyceridemia-induced acute pancreatitis.

Compared with patients with other causes of acute pancreatitis, those with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are more likely to develop persistent organ failure (POF). Therefore, recognizing the individuals at risk of developing POF early in the HTG-AP process is a vital for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP), a simple parameter that is obtained 24 h after admission, is an ideal index to predict HTG-AP severity; however, the suboptimal sensitivity limits its clinical application. Hence, current clinical scoring systems and biochemical parameters are not sufficient for predicting HTG-AP severity. To elucidate the early predictive value of red cell distribution width (RDW) for POF in HTG-AP. In total, 102 patients with HTG-AP were retrospectively enrolled. Demographic and clinical data, including RDW, were collected from all patients on admission. Based on the Revised Atlanta Classification, 37 (33%) of 102 patients with HTG-AP were diagnosed with POF. On admission, RDW was significantly higher in patients with HTG-AP and POF than in those without POF (14.4% vs 12.5%, P < 0.001). The receiver operating characteristic curve demonstrated a good discriminative power of RDW for POF with a cutoff of 13.1%, where the area under the curve (AUC), sensitivity, and specificity were 0.85, 82.4%, and 77.9%, respectively. When the RDW was ≥ 13.1% and one point was added to the original BISAP to obtain a new BISAP score, we achieved a higher AUC, sensitivity, and specificity of 0.89, 91.2%, and 67.6%, respectively. RDW is a promising predictor of POF in patients with HTG-AP, and the addition of RDW can promote the sensitivity of BISAP.

Clinical value of BISAP score combined with CRP and NLR in evaluating the severity of acute pancreatitis.

To investigate the clinical value of bedside index for severity in acute pancreatitis (BISAP) score combined with serum C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in predicting the severity of early acute pancreatitis. A total of 113 patients with acute pancreatitis admitted to the Department of Gastroenterology, Second Affiliated Hospital of Nantong University from September 2019 to September 2022 were retrospectively collected and divided into mild acute pancreatitis group (51 cases), moderately severe acute pancreatitis group (32 cases) and severe acute pancreatitis group (30 cases) according to the severity of the disease. The general clinical data, laboratory test indicators, and imaging data within 72 hours were collected and compared among the 3 groups. The sensitivity, specificity, and accuracy of BISAP score, BISAP combined with CRP, BISAP combined with NLR, and BISAP combined with CRP and NLR in predicting the severity of acute pancreatitis were analyzed by receiver operating characteristic curve. 1. BISAP score (0.9608 ± 0.1119, 1.688 ± 0.1225, 2.6 ± 0.1135), CRP (74.77 ± 8.336, 142.9 ± 11.44, 187.6 ± 13.04), and NLR (8.063 ± 0.7781, 13.69 ± 1.023, 18.06 ± 1.685) increased sequentially in mild acute pancreatitis group, moderately severe acute pancreatitis group, and severe acute pancreatitis group, and the differences in BISAP score, CRP and NLR among the 3 groups were statistically significant (P < .05). BISAP score was positively correlated with CRP and NLR (R = 0.5062, 0.5247, P < .05). The area under the receiver operating characteristic curve of BISAP score, CRP, NLR, BISAP combined with NLR, and BISAP combined with CRP in predicting the severity of acute pancreatitis were 0.885, 0.814, 0.714, 0.953, respectively. The specificity and sensitivity of combined diagnosis were higher than those of BISAP score or CRP and NLR alone. BISAP score combined with CRP and NLR can effectively evaluate the severity of acute pancreatitis, and their combination has a higher predictive value for early severity assessment.

Role of Red Cell Distribution Width and Platelet Count Ratio to Predict the Severity and Outcome in Acute Pancreatitis

Clinical course of acute pancreatitis (AP) varies widely, its clinical features exhibit very low sensitivity for the prediction of severity of disease which is associated with high morbidity and mortality. Several single or multi parameter scoring systems have been described to evaluate the severity of AP. But sometimes, it is not clinically practicable to use these scoring systems for evaluation. This study aimed to find out the Role of Red Cell Distribution Width and Platelet Count Ratio (RPR) to predict the Severity and Outcome in AP. This prospective longitudinal study was carried out from July 2019 to July 2020, at the in-patient department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders, BIRDEM General Hospital, Dhaka. Total 100 patients with AP were included for this study according to selection criteria. An informed written consent was taken from all the participants. Detail history was taken and thorough physical examination was done along with relevant laboratory investigations. Ranson's score, Modified Glasgow score, Bedside index of severity in acute pancreatitis (BISAP), red cell distribution width and platelet count ratio (RPR) were calculated. All data were recorded and analyzed by Statistical package for social sciences (SPSS) 23. In this study 44% patients were more than 60 years with a mean age of 51.34 (±15.45) year. More than two thirds patients were (67%) male. In mild acute pancreatitis  mean value of Ranson's score, BISAP score and modified Glasgow score was 0.79 (±0.14), 0.90 (±0.1) and 0.80 (±0.14) and 3.29 (±1.16), 1.77 (±0.46) ,2.74 (±0.69) in moderate to severe pancreatitis respectively with statistically difference were found in both severities (p&lt;.05). The patients with mild pancreatitis and the patients with moderate to severe pancreatitis had significant difference (p&lt;.05) between mean RDW (14.68±1.59% versus 15.51±3.27%), mean RPR (0.043±0.06 versus .062±.002) and platelet count (340.9±841.6 cells/mm3 Versus 236.4±825.4 cells/mm3). The ROC analysis of RPR in predicting severity of pancreatitis showed a cut-off value of ≥ 0.056 and diagnostic accuracy test showed sensitivity, specificity, PPV, NPV and accuracy as 63.6%, 82.2%, 81.4%, 64.9% and 72% respectively. Mean Ranson's score, BISAP score and Modified Glasgow score was 2.09 (±1.45), 1.34 (±0.39) and 1.83 (±1.08) in survived patients and 5.50 (±0.70), 4 and 3.50 (±0.70) in dead patients with significant difference between both groups (p&lt;.05). Mean RDW (15.08±2.67% Vs 17.85±0.21%), mean platelet count (284.43±143×109/L Vs 236.4± 825.4×109/L) and mean RPR (0.053±0.02 Vs 0.094± 0.005) was also significant between survived and dead patients (p&lt;.05). The ROC analysis of RPR in predicting outcome showed cut-off value of ≥ 0.06 and diagnostic accuracy test showed sensitivity, specificity, PPV, NPV and accuracy as 100%, 63.27%, 5.26%, 100% and 64% respectively. Red cell distribution width and platelet count ratio (RPR) can be used as a novel biomarker to predict the severity and mortality of acute pancreatitis in very early stage. Bangladesh Med J. 2021 Sept; 51(1): 18-24

Construction and validation of machine learning models for sepsis prediction in patients with acute pancreatitis

BackgroundThis study aimed to construct predictive models for the risk of sepsis in patients with Acute pancreatitis (AP) using machine learning methods and compared optimal one with the logistic regression (LR) model and scoring systems.MethodsIn this retrospective cohort study, data were collected from the Medical Information Mart for Intensive Care III (MIMIC III) database between 2001 and 2012 and the MIMIC IV database between 2008 and 2019. Patients were randomly divided into training and test sets (8:2). The least absolute shrinkage and selection operator (LASSO) regression plus 5-fold cross-validation were used to screen and confirm the predictive factors. Based on the selected predictive factors, 6 machine learning models were constructed, including support vector machine (SVM), K-nearest neighbour (KNN), multi-layer perceptron (MLP), LR, gradient boosting decision tree (GBDT) and adaptive enhancement algorithm (AdaBoost). The models and scoring systems were evaluated and compared using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the area under the curve (AUC).ResultsA total of 1, 672 patients were eligible for participation. In the training set, 261 AP patients (19.51%) were diagnosed with sepsis. The predictive factors for the risk of sepsis in AP patients included age, insurance, vasopressors, mechanical ventilation, Glasgow Coma Scale (GCS), heart rate, respiratory rate, temperature, SpO2, platelet, red blood cell distribution width (RDW), International Normalized Ratio (INR), and blood urea nitrogen (BUN). The AUC of the GBDT model for sepsis prediction in the AP patients in the testing set was 0.985. The GBDT model showed better performance in sepsis prediction than the LR, systemic inflammatory response syndrome (SIRS) score, bedside index for severity in acute pancreatitis (BISAP) score, sequential organ failure assessment (SOFA) score, quick-SOFA (qSOFA), and simplified acute physiology score II (SAPS II).ConclusionThe present findings suggest that compared to the classical LR model and SOFA, qSOFA, SAPS II, SIRS, and BISAP scores, the machine learning model-GBDT model had a better performance in predicting sepsis in the AP patients, which is a useful tool for early identification of high-risk patients and timely clinical interventions.

A Comparative Study of Bedside Index for Severity in Acute Pancreatitis (BISAP) and Acute Physiology and Chronic Health Evaluation II (Apache II) Score in Assessing the Severity of Acute Pancreatitis

Background: Acute pancreatitis is a common gastrointestinal disorder with substantial burden on the healthcare system. Since 1974, various scores have been developed using clinical and radiological parameters to assess the severity of acute pancreatitis. BISAP and APACHE II score have been developed for evaluation and to assess the severity of patients with acute pancreatitis. To evaluate BISAP and APACHE II score of patients with acute pancreatitis, compare sensitivity and specificity of BISAP and APACHE II score and to see predictive accuracy of BISAP and APACHE II score to analyse severity in acute pancreatitis. Material &amp; Methods: The study was conducted in the department of General Surgery, GGS Medical College and Hospital, Faridkot, on 40 diagnosed patients of acute pancreatitis. Results: The ROC analysis for organ failure showed BISAP score has AUC of 0.927, sensitivity of 100%, specificity of 75%, PPV of 30%, NPV 100% and diagnostic accuracy of 77.5%; whereas APACHE II score has AUC 0.983, sensitivity of 100%, specificity of 94.4%, PPV of 66.6%, NPV of 100% and diagnostic accuracy of 95%. The ROC analysis for pancreatic necrosis showed BISAP score has AUC of 0.882, sensitivity of 100%, specificity of 75%, PPV of 30.7%, NPV 100% and diagnostic accuracy of 77.5%; whereas APACHE II score has AUC 0.924, sensitivity of 100%, specificity of 77.7%, PPV of 33.3%, NPV of 100% and diagnostic accuracy of 80%. The ROC analysis for prediction of mortality has AUC (0.730, 0.735), sensitivity (66.6, 66.6%), specificity (73.53%, 79.41%), PPV (30.7%,33.6%), NPV(92.59%,93.1%)and diagnostic accuracy(72.5%, 77.5%), for BISAP and APACHEII scores, respectively. Conclusion: BISAP score was found to have sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy as close to APACHE II score in predicting the severity of acute pancreatitis. Even though APACHE II score is stronger to predict organ failure than BISAP but BISAP being simple, easy to calculate, economical and reliable can be used as preliminary tool to stratify patients and to manage accordingly for better outcome. Hence, using BISAP score, patients having probability of progressing to severe disease can be assessed early.

Decreased HDL-C Levels as a Predictor of Organ Failure in Acute Pancreatitis in the Emergency Department.

High-density lipoprotein cholesterol (HDL-C) is reported as a biomarker of systemic inflammation and multi-organ failure (MOF), which has been rarely investigated in acute pancreatitis (AP), a frequent condition in the emergency department (ED). The objective was to study the predictive capacity of the decrease in HDL-C to the progression of MOF in AP in the ED; analyzing 114 patients with AP for one year in a longitudinal and prospective study, AP severity was obtained by the Atlanta classification, in relation to modified Marshall and Bedside Index for Severity in Acute Pancreatitis (BISAP) scores, and clinical and laboratory parameters in a 48 h hospital stay. The area under the receiver operating characteristic (ROC) curve was used to estimate the validity of the predictor and define optimal cut-off points. It was found that AP was classified as severe in 24.5%, mainly for biliary etiology (78.9%) and female sex (73.6%). As a biomarker, HDL-C decreased from 31.6 to 29.5 mg/dL in a 48 h stay (p < 0.001), correlating negatively with the increase in severity index > 2 and the modified Marshall (p < 0.032) and BISAP (p < 0.009) scores, finding an area under the ROC curve with a predictive capacity of 0.756 (95% CI, 0.614-0.898; p < 0.004) and a cut-off point of 28.5 mg/dL (sensitivity: 79%, specificity: 78%), demonstrating that the decrease in HDL-C levels serves as a useful indicator with a predictive capacity for MOF in mild to severe AP, during a 48 h hospital stay in the ED.

A comparative evaluation of different scores in predicting severity and outcome in acute pancreatitis

Background: Acute pancreatitis (AP) is an inflammatory condition usually caused by alcohol or gallstones. Our goal was to prospectively compare the diagnostic efficacy of the Acute Physiology &amp; Chronic Health Evaluation (APACHE) II, the Bedside Index of Severity in Acute Pancreatitis (BISAP), the Ranson's score &amp; the Modified Glasgow Score (MGS) in determining the severity &amp; outcome of Acute pancreatitis in a tertiary care facility in central India. Methods: Between December 2020 &amp; December 2022, this prospective observational study was done in rural area of Wardha district. 110 subjects were included, and the diagnosis of acute pancreatitis was done using Atlanta criteria. APACHE II, MGS, Ranson score on admission, Ranson score 48 hours after admission &amp; BISAP were used to evaluate each subject. The reciever operating curve was used to measure the specificity, sensitivity, NPV, PPV, diagnostic accuracy, area under the curve (AUC) &amp; these scoring methods were then prospectively compared. Results: When a cut-off based on the literature was used, the APACHE II score could accurately diagnose severe cases of AP (n=110) in 69 patients, BISAP in 68 patients, MGS in 49, Ranson score on admission in 48 patients &amp; after 48 hours in 48 patients. This study showed that Ranson score 48 hours after admission had a AUC (0.991), Ranson score at admission (AUC 0.989) &amp; Modified Glasgow Scale (AUC 0.6486) had fair accuracy as compared to APACHE II (AUC 0.974) &amp; BISAP (AUC 0.896) for determining the level of severity among AP patients based on ROC curves. Conclusion: To predict the severity of AP, the Ranson score after 48 hours showed the highest NPV, PPV, sensitivity, specificity, and diagnostic accuracy of all the scoring methods tested. The BISAP score had the highest specificity, sensitivity, PPV&amp; NPV for determining the outcome of AP.

The utility of the bedside index of severity in acute pancreatitis at prognosticating adverse outcomes.

Identification of at-risk patients with acute pancreatitis (AP) early on in the course of hospital admission remains a challenge. Early identification of these patients can facilitate early referral to tertiary hospitals with skilled multidisciplinary teams (MDTs) and high-dependency health care facilities. This study retrospectively reviewed the ability of the bedside index of severity in acute pancreatitis (BISAP) score and other biochemical markers to predict organ failure and mortality in acute pancreatitis. All patients presenting to Grey's Hospital with AP between 2012 and 2020 were included in the study. The BISAP score and other biomarkers were evaluated at presentation in predicting organ failure (≥ 48 hours duration) and mortality. A total of 235 patients were included in the study. A total of 144 (61%) were male and 91 (39%) were female. Alcohol (81%) and gallstones (69%) were the commonest aetiological factors amongst males and females respectively. A total of 42 (29%) males and 10 (11%) females developed organ failure during their hospital stay. The mortality rate was 11.8% for males, 6.59% for females, with an overall mortality of 9.8%. A BISAP score of 2 had a sensitivity of 87.98% and specificity of 59.62% at predicting organ failure (positive predictive value [PPV] = 88.46%, negative predictive value [NPV] = 58.49%, 95% confidence interval [CI], p = 0.001). A BISAP score of 3 and above had a sensitivity of 98.11% and specificity of 69.57% at predicting mortality (PPV = 96.74%, NPV = 80%, 95% CI, p = 0.001). A multivariate analysis of biomarkers bicarbonate, base excess, lactate, urea and creatinine either failed to reach statistical significance or had specificity that is too low to prognosticate organ failure and mortality. The BISAP score has limitations at predicting organ failure, but it is a reliable tool for predicting mortality in AP. Due to its simplicity of use, it should be used in resource-constrained settings to triage at-risk patients in smaller hospitals, for early referral to tertiary hospitals.

Development and Validation of a Dynamic Nomogram for Predicting in-Hospital Mortality in Patients with Acute Pancreatitis: A Retrospective Cohort Study in the Intensive Care Unit.

The aim of this study is to develop and validate a predictive model for the prediction of in-hospital mortality in patients with acute pancreatitis (AP) based on the intensive care database. We analyzed the data of patients with AP in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and Electronic Intensive Care Unit Collaborative Research Database (eICU-CRD). Then, patients from MIMIC-IV were divided into a development group and a validation group according to the ratio of 8:2, and eICU-CRD was assigned as an external validation group. Univariate logistic regression and least absolute shrinkage and selection operator regression were used for screening the best predictors, and multivariate logistic regression was used to establish a dynamic nomogram. We evaluated the discrimination, calibration, and clinical efficacy of the nomogram, and compared the performance of the nomogram with Acute Physiology and Chronic Health Evaluation II (APACHE-II) score and Bedside Index of Severity in AP (BISAP) score. A total of 1030 and 514 patients with AP in MIMIC-IV database and eICU-CRD were included in the study. After stepwise analysis, 8 out of a total of 37 variables were selected to construct the nomogram. The dynamic nomogram can be obtained by visiting https://model.sci-inn.com/KangZou/. The area under receiver operating characteristic curve (AUC) of the nomogram was 0.859, 0.871, and 0.847 in the development, internal, and external validation set respectively. The nomogram had a similar performance with APACHE-II (AUC = 0.841, p = 0.537) but performed better than BISAP (AUC = 0.690, p = 0.001) score in the validation group. Moreover, the calibration curve presented a satisfactory predictive accuracy, and the decision curve analysis suggested great clinical application value of the nomogram. Based on the results of internal and external validation, the nomogram showed favorable discrimination, calibration, and clinical practicability in predicting the in-hospital mortality of patients with AP.

Correlation between BISAP score and D-dimer level on their predictive ability to determine the severity of acute pancreatitis at 24-hours of hospital admission: an observational study

Background: Early prediction of severity of acute pancreatitis (AP) is important for management of AP patients with escalation of care and aggressive therapy which can reduce complications. Bedside index of severity in AP (BISAP) score is helpful in early diagnosis of severe AP. D-dimer, a biomarker of secondary fibrinolysis may be helpful in predicting the severity of pancreatitis. Aims and Objectives: The objective of this study was to evaluate the two scoring systems - the BISAP score and D-dimer in early prediction (within 24 h) on the severity of AP and to analyze how D-dimer correlates with BISAP score. Materials and Methods: Seventy-five patients, aged 18–70 years, suffering from AP due to any cause were included for this prospective, observational study. Within 24 h of admission D-dimer was estimated and BISAP score was calculated. The severity was assessed based on D-dimer level and BISAP scoring systems within 24 h of hospital admission and data were tabulated for analysis. The D-dimer level &gt;2.5 mg/L was considered to be suggestive of severe pancreatitis. The BISAP score &gt;2 in first 24 h was defined as predictive of severe pancreatitis. Spearman rank correlation was used for an analysis of the association between two set of data (BISAP scores and d-dimer levels) and thus to measure the strength and direction of the relationship between the two variables. Results: In the present study, 37.3% of the patients had D-dimer ≤2.5 mg/L and 62.7% had D-dimer&gt;2.5 mg/L’ on calculating the Pearson’s correlation on the ranked values of the data (BISAP scores and D-dimer levels), the correlation coefficient (Spearman’s Rho, designated as “rs”) was found to be 0.406 which indicates about moderate positive correlation. Conclusion: D-dimer testing can be used as an alternative test to predict the severity of AP. It shows a moderate correlation with BISAP scoring.

Predictive value of the C-reactive protein/albumin ratio in severity and prognosis of acute pancreatitis.

To investigate the predictive value of C-reactive protein (CRP) to serum albumin (ALB) ratio in the severity and prognosis of acute pancreatitis (AP), and compare the predictive value of the CRP/ALB ratio with the Ranson score, modified computed tomography severity index (MCTSI) score, and Bedside Index of Severity in Acute Pancreatitis (BISAP) score. This cohort study retrospectively analyzed clinical data of AP patients from August 2018 to August 2020 in our hospital. Logistic regression analysis was utilized to determine the effects of CRP/ALB ratio, Ranson, MCTSI, and BISAP score on severe AP (SAP), pancreatic necrosis, organ failure, and death. The predictive values of CRP/ALB ratio, Ranson, MCTSI, and BISAP score were examined with the area under the curve (AUC) of the receiver operator characteristic (ROC) curve analysis. DeLong test was used to compare the AUCs between CRP/ALB ratio, Ranson, MCTSI, and BISAP score. Totally, 284 patients were included in this study, of which 35 AP patients (12.32%) developed SAP, 29 (10.21%) organ failure, 30 (10.56%) pancreatic necrosis and 11 (3.87%) died. The result revealed that CRP/ALB ratio on day 2 was associated with SAP [odds ratio (OR): 1.74, 95% confidence interval (CI): 1.32 to 2.29], death (OR: 1.73, 95%CI: 1.24 to 2.41), pancreatic necrosis (OR: 1.28, 95%CI: 1.08 to 1.50), and organ failure (OR: 1.43, 95%CI: 1.18 to 1.73) in AP patients. Similarly, CRP/ALB on day 3 was related to a higher risk of SAP (OR: 1.50, 95%CI: 1.24 to 1.81), death (OR: 1.8, 95%CI: 1.34 to 2.65), pancreatic necrosis (OR: 1.22, 95%CI: 1.04 to 1.42), and organ failure (OR: 1.21, 95%CI: 1.04 to 1.41). The predictive value of CRP/ALB ratio for pancreatic necrosis was lower than that of MCTSI, for organ failure was lower than that of Ranson and BISAP, and for death was higher than that of MCTSI. The CRP/ALB ratio may be a novel but promising, easily measurable, reproducible, non-invasive prognostic score that can be used to predict SAP, death, pancreatic necrosis, and organ failure in AP patients, which can be a supplement of Ranson, MCTSI, and BISAP scores.

ETIOLOGY, CLINICAL PROFILE, ASSESSMENT AND COMPARISON OF SCORING SYSTEMS IN PATIENTS DIAGNOSED WITH ACUTE PANCREATITIS IN A TERTIARY CARE CENTRE

Background:Acute pancreatitis is a sudden inammation of the pancreas with an incidence 13–45 /1,00,000. A Bedside Index for Severity in Acute Pancreatitis (BISAP) has recently been proposed as an accurate and simple method for early identication of persistent organ failure and mortality. CT, as used to aid the diagnosis and staging of acute pancreatitis, has greatly improved and has changed the clinical management of this condition. 50 patients who came Methods: with acute abdomen and diagnosed with acute pancreatitis were selected satisfying inclusion and exclusion criteria. BISAP score and CT severity index was calculated and compared. Results: Out of 50 patients mild, moderate and severe acute pancreatitis was identied in 35, 9 and 6 patients respectively based on CT severity score index(CTSI). Out of 50 cases,47 had BISAP score &lt; 3 and 3 had &gt;3.BISAP score as a predictor of prognosis has a signicant relation as evident by the data in our study (p value&lt;0.05).BISAP score and CTSI are used for severity assessment of acute pancreatitis, both these scoring systems showed positive correlation in assessing the severity. Early evaluation of the Conclusion: severity of acute pancreatitis is essential to allow the clinician to predict the patient's clinical course, estimate prognosis, and determine the need for admission to the intensive care unit. BISAP score is relatively simple &amp;amp; accurate in predicting the clinical severity of Acute Pancreatitis with a prognostic accuracy of BISAP similar to CTSI.

Expression levels of RUNX3 and FGFR2 in peripheral blood of severe acute pancreatitis and their clinical significance.

Severe acute pancreatitis (SAP) is a life-threatening inflammatory syndrome of the pancreas. This study aimed to analyze the clinical significance of runt-associated transcription factor 3 (RUNX3) and fibroblast growth factor receptor 2 (FGFR2) expression alterations in SAP. This study included 18 SAP patients in Wuzhong People's Hospital from November 2019 to December 2021 and 18 healthy controls. RUNX3 and FGFR2 expression levels were determined by RT-quantitative PCR. Correlations between RUNX3/FGFR2 and sex, age, etiology, CRP, procalcitonin, AST, LDH, BUN, Acute Physiology and Chronic Health Evaluation II (APACHE II), Ranson score, Bedside Index for Severity in Acute Pancreatitis (BISAP) score, sequential organ failure assessment (SOFA), and modified computed tomography severity index (MCTSI) score were analyzed. Diagnostic values of RUNX3 and FGFR2 in SAP were analyzed using the receiver-operating characteristic curve. The binding of RUNX3 to FGFR2 was analyzed by chromatin immunoprecipitation. RUNX3 and FGFR2 were downregulated in peripheral blood of SAP patients. RUNX3 and FGFR2 were negatively correlated with CRP, procalcitonin, AST, LDH, BUN, APACHE II score, Ranson score, BISAP score, SOFA score, and MCTSI score. Sensitivity and specificity of RUNX3 level of <0.9650 for SAP diagnosis were 88.89% and 72.22%, respectively. Sensitivity and specificity of FGFR2 level of <0.8950 for SAP diagnosis were 66.67% and 83.33%, respectively. RUNX3 was enriched in the FGFR2 promoter and was positively correlated with FGFR2. RUNX3 and FGFR2 were downregulated in peripheral blood of SAP patients and served as candidate biomarkers for SAP diagnosis. RUNX3 bound to the FGFR2 promoter to promote FGFR2 transcription.

Acute pancreatitis due to hypertriglyceridemia: Plasmapheresis versus medical treatment

OBJECTIVE: Hypertriglyceridemia (HTG) is the third-most common cause of acute pancreatitis. Plasmapheresis is an extracorporeal treatment method used for treatment. This study aimed to investigate the efficacy of medical treatment and plasmapheresis in patients with acute pancreatitis due to HTG. METHODS: This was a retrospective cross-sectional study. The patients were divided into two groups according to the treatment they received as those who received only medical treatment and those who performed plasmapheresis with medical treatment. According to the treatment received by the patients; clinical, demographic, and laboratory data, Ranson scores, and bedside index of severity in acute pancreatitis (BISAP) scores, decrease in triglyceride levels in 24 h, length of hospital stay, and outcomes were recorded. RESULTS: Forty-seven patients were included in the study. The level of triglyceride decreases at the 24th h was 59.7% ±17.3% in those who received medical treatment and was 70.4% ±15.1% in those who received plasmapheresis (P = 0.032). Receiver operating characteristic curve analysis was performed to predict the need for plasmapheresis treatment, area under the curve (AUC) value of the triglyceride level was the highest (AUC: 0.822, 95% confidence interval: [0.703–0.940]; P < 0.001), the sensitivity and specificity were 83.3% and 72.4%, respectively, and the cut-off value of triglyceride was accepted as 3079.5 mg/dL. CONCLUSION: Plasma triglyceride levels and BISAP score on admission may help physicians to predict the need for plasmapheresis. Plasmapheresis helps to rapidly reduce triglyceride levels in patients with HTG-associated acute pancreatitis.

Predicting the Success of Catheter Drainage in Infected Necrotising Pancreatitis: A Cross-Sectional Observational Study.

Background Management of acute necrotising pancreatitis is often challenging for clinicians. Secondary infection of the necrotic collections leads to sepsis and warrants intervention. Minimally invasive techniques like catheter drainage have recently been proposed over more risky and morbid traditional open procedures. Factors that can predict successful catheter drainage of the necrotic pancreatic collection are still unclear and not well established. Materials and methods This study is designed as a retrospective cross-sectional observational study to investigate the association of 21 factors in predicting successful catheter drainage. Data from 30 patients admitted with acute necrotising pancreatitis treated with catheter drainage were collected and analysed. Twenty-one factors, including demographic variables, disease severity factors, drainage criteria, and morphological criteria on imaging, were studied for their predictive association with successful outcomes. Univariate analysis was done for each variable against the outcome. The study was conducted between December 2012 to March 2017. P-value <0.05 was considered statistically significant. Results Patients with no organ involvement responded better to primary catheter drainage. Patients with BMI>25 and multi-organ failure were poor candidates for primary catheter drainage. Clinically unwell patients with a Bedside Index for Severity in Acute Pancreatitis (BISAP) score of ≥4 had a negative outcome on catheter drainage and usually ended up in a surgical procedure or eventually succumbed to the disease. Other variables included in our study did not statistically associate with the success or failure of percutaneous catheter drainage. Conclusion BMI >25, multiple organ failure, and BISAP score ≥ 4 are independent negative predictors for the success of catheter drainage in infected necrotising pancreatitis. No organ failure showed a positive predictor for successful catheter drainage. Further studies are required to explore these predictive factors in a larger sample size to predict the success of catheter drainage in infected pancreatic necrosis.

Evaluation of acute pancreatitis based on BISAP scoring system: A cohort study of 50 cases

Abstract Background/Aim Acute pancreatitis is encountered in both medical and surgical specialty. Assessment of severity and grading is done using radiological investigations mostly like ultrasonography or CECT. We present a study to assess the severity of Acute Pancreatitis based on Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system. Material &amp; Methods The study was conducted on 50 patients presenting with acute pancreatitis who were included as per inclusion criteria and a detailed history, clinical examination and blood investigation performed. Data like serum amylase, serum lipase, serum calcium, blood urea nitrogen (BUN), pleural effusion and systemic inflammatory response syndrome (SIRS) was collected from the patients. Based on data collected in 24 hours of hospitalization, BISAP score was calculated. Results Results showed that no significant temperature rise, pancreatic necrosis, SIRS or impaired mental status in patients with BISAP severity of &lt;=3. However, patients having BISAP score &gt;3, factors like BUN, age, pleural effusion, and organ failure show significant correlation. Also on comparative analysis of patients showed that the hospital stay, respiratory rate, pulse and laboratory markers (blood urea, serum creatinine, serum amylase, serum lipase) were significantly higher in patients with BISAP score ≥3. Conclusion BISAP score is an easy, quick and bedside method to assess the severity of acute pancreatitis and predict its mortality. It is easy bedside procedure that can be done in every setup.