ABSTRACT
Background: Acute pancreatitis is an acute inflammation of the pancreas is an increasingly common abdominal disorder presenting as major surgical challenge to general surgeons worldwide. Early identification of patients at risk of developing a severe attack has great importance for instituting therapeutic interventions and improved outcome. Accurate prediction of severity is important in order to improve survival. There are several assessment criteria in order to predict prognosis and severity of acute pancreatitis, which help in guiding patient triage and management. However, nothing is proven to perform significantly better in clinical settings than good clinical judgment. Ideal predicting criteria should, therefore be simple, non-invasive, accurate and quantitative and assessment tests are easily available. Aim and objectives: It was a prospective study to assess the accuracy of BISAP scoring system vs Ranson’s scoring system in predicting Severity in an attack of acute pancreatitis and to compare predictability of organ failure, necrosis and mortality between BISAP scoring and Ranson’s Scoring system. Materials and methods: All patients admitted to Govt. Stanley Hospital with complaints of pain abdomen diagnosed to have Acute Pancreatitis on clinical examination and further investigations. Sample size consists of 100 patients with acute pancreatitis. BISAP score and Ranson’s score is calculated in all such patients based on data obtained within 24 hours of hospitalization and at 48 hours. Results: In this study, the two different scoring systems (BISAP and Ranson’s) were compared and analyzed to assess the severity in patients with acute pancreatitis. An attempt also made to compare this study with previous similar studies done by others. Acute pancreatitis found to be 10 times more J. Lalithkumar, T. Chitra, N. Kodieswaran. Comparative study between BISAP and Ranson’s score in predicting severity of acute pancreatitis. IAIM, 2016; 3(9): 23-33. Page 24 common in males than females in this study. The mean length of hospital stay was 12.03 ± 6.8 days in this study. In this study, increasing BISAP and Ranson’s scores was correlated well with the duration of hospital stay. In this study, 86 patients were diagnosed to have mild and moderately severe acute pancreatitis grouped under MAP, and 14 patients found to have severe acute pancreatitis. All the 14 patients were correctly predicted by BISAP score. The scores were assessed by correlating the scores with three factors: organ failure, necrosis and mortality. The analysis for organ failure showed BISAP score has sensitivity of 71.43%, specificity of 95.35%, PPV of 71.43%, NPV of 95.35%, diagnostic accuracy of 92%; whereas Ranson’s score has sensitivity of 78.57%, specificity of 74.42%, PPV of 43.33%, NPV of 95.52 %, diagnostic accuracy of 88%. In this study, 7/20 patients with BISAP> 3 and 8/14 patients with Ranson’s >3, developed pancreatic necrosis. The statistical analysis for the prediction of necrosis has sensitivity of (81.82%, 90.91%), specificity of (94.35%, 77.53%), PPV of (64.29%, 43.56%), NPV of (97.67%, 98.57%), diagnostic accuracy of (93%, 91%) for BISAP and Ranson’s respectively. In this study, 4 patients with severs acute pancreatitis were expired. All 4 deaths were correctly predicted by BISAP score. The statistical analysis for the prediction of necrosis has sensitivity of (100%, 88.57%), specificity of (95.83%, 64.42%), PPV of (50%, 31.33%), NPV of (100%, 96.52%), diagnostic accuracy of (96%, 93%) for BISAP and Ranson’s respectively. In this study, patients developed pancreatic necrosis, acute renal failure, MODS, septicemia. These complications were more likely seen in patients with BISAP ≥ 3, and Ranson’s > 3, hence concluded that these are the patients in high risk group, who requires intensive monitoring and probably early intervention if necessary. Conclusion: From this study, alcohol (59%) was found to be the most common etiological factor for acute pancreatitis. Males were more commonly affected than females with a ratio of 10:1. The most common age groups of patients affected were in 4th decade of life. The overall mortality in patients with severe acute pancreatitis was 4% BISAP score is equally effective in finding out the frequency of severity and predicting mortality in patients with acute pancreatitis as Ranson's score. Moreover, its components are easily available and it does not require 48 hours for completion of assessment as compared to Ranson's score. It is an accurate tool to classify patients into mild and severe disease; it is easy to perform and can be done on the bedside of patients with acute pancreatitis in every setup.