Comparison of BISAP and Ranson’s score for predicting severe acute pancreatitis and establish the validity of BISAP score

Background: Pancreatitis can lead to serious complications with severe morbidity and mortality. So an early, quick and accurate scoring system is necessary to stratify the patients according to their severity so as to enable early initiation of required management and care. Scoring system commonly used have some drawbacks. This study aimed to compare bedside index for severity in acute pancreatitis (BISAP) and Ranson’s score to predict severe acute pancreatitis and establish the validity of a simple and accurate clinical scoring system for stratifying patients.Methods: This is a prospective comparative study on 100 patients diagnosed with acute pancreatitis admitted in department of general surgery. Parameters included in the BISAP and Ranson’s criteria were studied at the time of admission and after 48 hours. Result of these two were compared with that of revised Atlanta classification.Results: As per the BISAP score, the sensitivity and specificity were 95.8 % (95% CI, 76.8-99.8), 94.7 % (95% CI, 86.3-98.3) whereas positive likelihood ratio, negative likelihood ratio 18.21 (95% CI, 6.9-47.44), 0.04 (95% CI, 0.01-0.30) and accuracy was 95 % (95% CI, 88.72%-98.36%). On using Ranson’s score, the sensitivity and specificity were 91.6 (95% CI, 71.5-98.5) and 89.4 (95% CI, 79.8-95) with a positive predictive value 8.71 (95% CI, 4.47-18.96) and negative predictive value of 0.09 (95% CI, 0.02-0.35) and accuracy of 90% (95% CI, 82.38%-95.10%)..Conclusions: BISAP score outperformed Ranson’s score in terms of Sensitivity and specificity of prediction of severe pancreatitis. The authors recommend inclusion of BISAP Scoring system in standard treatment protocol of management of acute pancreatitis.

Comparison of three classification systems for acute pancreatitis / 中华急诊医学杂志

Objective To compare the accuracy of three classification systems [determinant based classification (DBC),Revision of the Atlanta classification (RAC),and Atlanta classification (AC)] to stratify severity of acute pancreatitis (AP),and to analyze the association between different severity categories and clinical outcomes.Methods In this retrospective study,we reviewed the clinical data of 458 patients with AP admitted to our unit from January 2015 to December 2017.AP severity was stratified according to the three classification systems (DBC,RAC,and AC) respectively.The classification accuracy of three classification systems was analyzed.Receiver operating characteristic analysis (area under the curve) compared the accuracy of each classification.Multi-factors logistic regression analysis identified the independent risk fators for mortality of AP.Results Among the three classification systems,there were significant differences in the mortality rate,invasive treatment rate,ICU monitoring rate and the average hospitalization time among the three subtypes (P＜0.001).The RAC and DBC were comparable,but performed better than AC in predicting mortality (AUC 0.94 and 0.95 vs.0.63,P＜0.001),ICU admission (AUC 0.90 and 0.88 vs 0.60,P＜0.001).The DBC performed better than the RAC and OAC in predicting the need for intervention (AUC 0.88 vs 0.69 and 0.68,P＜0.001).Persistent organ failure (OR=13.131,P=0.003) and infected necrosis(OR=9.424,P=0.014) were independent risk factors for mortality.Conclusion The accuracy of DBC and RAC to stratify the severity of AP was significantly higher than that of AC.The accuracy of DBC in predicting clinical outcome was genarally higher than that of RAC and AC.Infectious necrosis and persistent organ failure were the independent risk fators for mortality.

A comparison between the revision of Atlanta classification and determinant-based classification in acute pancreatitis / 中华内科杂志

Objective To compare the performance of the revision of Atlanta classification (RAC) and determinant-based classification (DBC) in acute pancreatitis. Methods Consecutive patients with acute pancreatitis admitted to a single center from January 2001 to January 2015 were retrospectively analyzed. Patients were classified into mild, moderately severe and severe categories based on RAC and were simultaneously classified into mild, moderate, severe and critical grades according to DBC. Disease severity and clinical outcomes were compared between subgroups. The receiver operating curve (ROC) was used to compare the utility of RAC and DBC by calculating the area under curve (AUC). Results Among 1120 patients enrolled, organ failure occurred in 343 patients (30.6%) and infected necrosis in 74 patients (6.6%). A total of 63 patients (5.6%) died. Statistically significant difference of disease severity and outcomes was observed between all the subgroups in RAC and DBC (P<0.001). The category of critical acute pancreatitis (with both persistent organ failure and infected necrosis) had the most severe clinical course and the highest mortality (19/31, 61.3%). DBC had a larger AUC (0.73, 95%CI 0.69-0.78) than RAC (0.68, 95%CI 0.65-0.73) in classifying ICU admissions (P=0.031), but both were similar in predicting mortality(P=0.372) and prolonged ICU stay (P=0.266). Conclusions DBC and RAC perform comparably well in categorizing patients with acute pancreatitis regarding disease severity and clinical outcome. DBC is slightly better than RAC in predicting prolonged hospital stay. Persistent organ failure and infected necrosis are risk factors for poor prognosis and presence of both is associated with the most dismal outcome.

The comparison of the 1992 and 2012 Atlanta classifications for assessing disease severity in patients with acute pancreatitis / 中华内科杂志

Objective To compare the discrepancy between the new (2012) and the old (1992) Atlanta classification criteria for defining severity, organ failure and local complications in patients with acute pancreatitis (AP).Methods Demographic, clinical and laboratory data of 2 305 consecutive AP patients with onset less than 3 days, were collected between January 2005 to December 2013 in the First Affiliated Hospital of Nanchang University.Severity, organ failure and pancreatic local complications were respectively classified by the old Atlanta classification and the new revised Atlanta classification.Multi-factor scoring system and single serum marker were recorded and calculated using the acute pancreatitis database.Results In 2 305 patients with AP, there were 301 cases (13.1％) diagnosed with acute respiratory failure, 136 cases (5.9％) with shock, 105 cases (4.6％) with acute renal failure, 296 cases (12.8％) with gastrointestinal bleeding, based on the old Atlanta classification criteria.According to the severity, 900 cases (39.0％) were classified as mild acute pancreatitis (MAP), 1 405 cases (61.0％) as severe acute pancreatitis (SAP).However, based on the new Atlanta classification criteria, there were 686 cases (29.8％) with acute respiratory failure, 129 cases (5.6％) with acute renal failure, 107 cases (4.6％) with circulatory failure.Consequently, 998 cases (43.3％) were classified as MAP, 937 cases (40.7％) as moderately severe acute pancreatitis (MSAP), 370 cases (16.1％) as SAP.The incidence of respiratory failure was lower than that of the old standard.In SAP patients by new criteria, the discharge rate in critical condition and mortality were not only higher than those in MSAP patients (17.0％ vs 4.1％, 4.1％ vs 1.5％, respectively , all P ＜ 0.001), but also higher than those in SAP patients by the old classification (17.0％ vs 7.2％ ,4.1％ vs 2.1％, all P ＜ 0.001).Conclusions The diagnostic criteria of organ failure are different between the new and old Atlanta classification.The SAP patients classified by the new standard have worse outcome than those by the old standard.More attention needs to be paid to critical patients stratified by the new standard.

Diagnosis, treatment and prognosis of patients with acute pancreatitis / 中华肝胆外科杂志

Acute Pancreatitis Classification Working Group published Classification of Acute Pancreatitis-2012:Revision of the Atlanta Classification and Definitions by International Consensus in 2012,which redefined the diagnosis,severity,local complication,local infection of acute pancreatitis (AP).Under the guidance of revised Atlanta classification (RAC),the constituent ratio of severe acute pancreatitis (SAP) decreases significantly,which is between 3.7％ ～ 25.4％,and less than 10.0％ is reported in most researches.The mortality of SAP is between 10.0％ ～ 52.9％,and more than 20％ is observed in most publications.The constituent ratio of mild severe acute pancreatitis (MSAP) is between 10.9％ ～ 40.1％,the mortality is between 0 ～ 4.8％,and the incidence rate of organ failure is between 4.6％ ～ 34.0％.The percentage of patients with SAP who need ICU care and surgery intervention is higher than that of MSAP,and the total hospital stay of SAP are longer than that of MSAP.RAC could better reflect the severity and predict the outcome of AP than Atlanta classification published in 1992,but RAC also has some potential limitations.For example,the “local infection” is not included in this classification.This paper veviewed the relavent issues.

Validation of the revised Atlanta classification and the determinant-based classification for severity of acute pancreatitis / 中华肝胆外科杂志

Objective To validate the accuracy of the revised Atlanta classification (RAC) and the determinant-based classification (DBC) for severity of acute pancreatitis.Methods We retrospectively analysed the clinical data from 192 patients with acute pancreatitis who were admitted to our hospital between January 2014 and October 2014.Using the RAC and the DBC,The duration of total parenteral nutrition,length of ICU and hospital stay,operation rate and mortality were assessed in the subgroups,respectively.Results Fluid collections in and around the pancreas was present in 74 patients (38.5％),pancreatic or peripancreatic necrosis in 51 (26.6％),and infection in 18 (9.4％).On the basis of the RAC,106 patients (55.2％),77 patients (40.1％),and 9 patients (4.7％) were classified to have mild,moderately severe,or severe AP,respectively.On the basis of the DBC,11l (57.8％),62 (32.3％),14 (7.3％),and 5 (2.6％) patients were classified to have mild,moderate,severe,or critical AP,respectively.The different categories of severity for each classification system were significantly associated with the duration of total parenteral nutrition,the length of ICU and hospital stay,the operation rate and mortality.Conclusion Both the RAC and DBC accurately classified the severity of AP and differentiated prognosis in the subgroups of patients.

Protocolo de tratamiento y resultados de pancreatitis aguda: estudio de cohorte / Retrospective review of 251 patients with acute pancreatitis

Background: The severity of acute pancreatitis (AP) can be assessed using the Atlanta classification. Different clinical guides have been developed for the diagnosis and treatment of this condition. Aim: To report a retrospective series of patients with AP. Material and Methods: Review of medical records of 251 patients with AP, aged 53 +/- 18 years (54 percent females). Severity was assessed using Atlanta classification, the acute physiology and chronic health evaluation (APACHE) II score and C reactive protein (CRP) were used as prognostic indicators. Results: Cholelithiasis was the etiology of pancreatitis in 85 percent of patients. According to Atlanta classification 68 percent had a mild disease. Seven percent of patients had local complications and 9 percent died. Conclusions: Biliary lithiasis was the most common etiology of AP in this series of patients and 68 percent had a mild disease.

Introducción: La pancreatitis aguda (PA) es una patología asociada a una significativa morbilidad y mortalidad. La clasificación de gravedad se basa en los criterios de Atlanta. Diversas guías clínicas han sido desarrolladas para el diagnóstico y tratamiento de esta patología. Nuestro objetivo es describir la experiencia en el diagnóstico y tratamiento de la PA y evaluar los predictores de gravedad utilizados con la morbilidad y mortalidad asociada a esta patología en un centro de referencia. Materiales y Método: Cohorte retrospectiva de pacientes con diagnóstico de PA entre enero de 2005 y diciembre de 2006. La gravedad fue determinada según los criterios de Atlanta. Los predictores de gravedad utilizados han sido modificados de la guía clínica del Reino Unido. Resultados: Se incluyeron 253 pacientes con PA. La etiología más frecuente fue la patología litiásica biliar en un 84,5 por ciento. El 32 por ciento de los pacientes presentó una pancreatitis aguda grave (PAG). Complicaciones locales se presentaron en 7 por ciento de los pacientes. La mortalidad global de la serie fue de un 9 por ciento. Conclusiones: La etiología más frecuente de PA en nuestro centro es la litiasis biliary el cuadro clínico leve. Nuestra serie presenta un porcentaje elevado de pacientes con PAG, con porcentajes de complicaciones y mortalidad comparable con cifras nacionales e internacionales.