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Objective:To investigate the predictive value of intra-abdominal pressure (IAP) combined with bedside index for severity in acute pancreatitis (BISAP) score on the severity and prognosis of acute pancreatitis (AP).Methods:In this retrospective study, 204 AP patients admitted to the Department of ICU, Second Hospital of Anhui University from Jan 2015 to Dec 2020 were divided based on the severity: into SAP group (145 cases) and Non-SAP group (59 cases) with end point survival (177 cases) and death (27 cases). The receiver operating characteristic (ROC) curves were drawn, and the predictive value of IAP, BISAP score and I-B (IAP and BISAP scores) in the severity and the prognosis of AP was studied. Medcalc software was used to compare the areas under ROC curve for different predictors.Results:IAP and BISAP scores increased with the severity of AP ( P<0.001), the area under the ROC curve (AUC) was 0.791, 0.749 and 0.907 respectively,comparison of area under ROC curve showed that I-B combined assessment was superior to IAP value and BISAP score alone in predicting severity ( P<0.05). IAP and BISAP scores were higher in the death group than in the survival group ( P<0.001). The ROC curve results of IAP, BISAP score and I-B combined on the prognosis of AP showed that the AUC was 0.773, 0.841 and 0.950, respectively,comparison of area under ROC curve showed that I-B combined assessment was superior to IAP and BISAP score alone in predicting prognostic value ( P<0.05). Conclusion:Both IAP and BISAP scores can better predict the severity of and the prognosis of AP, and the combination of IAP and BISAP score is more valuable for prediction of prognosis in AP.
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Objective:To explore the value of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) combined with bedside index for severity in acute pancreatitis (BISAP) score in predicting severe acute pancreatitis (SAP) in patients with hypertriglyceridemia pancreatitis (HTGP).Methods:Patients who met the diagnostic criteria of HTGP were retrospectively collected in the Emergency Department of Peking University People's Hospital from January to December in 2019. Patients were assigned to two groups according to the severity of acute pancreatitis: the mild acute pancreatitis group and severe acute pancreatitis (SAP) group. Blood samples were taken within 24 h after the onset of HTGP for analysis. White blood cell count, neutrophil count, lymphocyte count, and other laboratory indicators were detected. BISAP score was performed, and NLR and PLR were calculated in all patients within 24 h of the onset of HTGP. Comparison of various indicators was performed in the two groups. The risk factors of SAP patients with HTGP were analyzed by Logistic regression. The correlation of risk factors was analyzed by correlation. The receiver operating characteristic (ROC) curve was drawn, and the optimal thresholds of NLR and PLR were calculated respectively. The BISAP score, NLR combined with BISAP score (BN score), PLR combined with BISAP score (BP score), and NLR, PLR combined with BISAP score (BNP score) were compared respectively to predict SAP in patients with HTGP.Results:A total of 82 patients were collected. There were significant differences in the proportion of patients with fever, NLR, PLR, lactate dehydrogenase, urea nitrogen, Ranson score, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score and BISAP score between the two groups (all P<0.05). Logistic regression analysis showed that NLR ( OR=1.859, 95% CI: 1.385-2.497, P<0.001), PLR ( OR=1.074, 95% CI: 1.036-1.112, P<0.001) and BISAP score ( OR=2.880, 95% CI: 1.578-5.258, P=0.001) were risk factors for severe HTGP. Correlation analysis confirmed that NLR and PLR were positively correlated with BISAP, APACHE Ⅱand Ranson score. The AUC of BISAP score, BN score, BP score and BNP score for predicting SAP in HTGP were 0.865 (95% CI: 0.787-0.943), 0.925 (95% CI: 0.869-0.981),0.930 (95% CI: 0.885-0.987), and 0.936 (95% CI: 0.874-0.986). Conclusions:NLR and PLR combined with BISAP score has a higher sensitivity to predict the severity of HTGP, which can predict severe pancreatitis within 24 h of the onset of HTGP, so that providing better guidance for treatment.
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Background: Acute pancreatitis though a self limiting in 80-90% of cases, but in 10-20% cases there is pancreatic necrosis, multi-organ failure & recurring pancreatic injury . A simple accurate, clinical scoring system BISAP (Bed side index for severity in acute pancreatitis) collected data within 24hrs of admission to hospital in predicting patients at risk for developing organ failure, persistent organ failure and pancreatic necrosis. Methods: A prospective study done at SCB MCH, from Aug.2016 to Sept.2018. All patients admitted to the hospital as acute pancreatitis are included in this study which is characterized by acute abdominal pain, increased level of serum amylase and/or lipase, USG/CT/MRI of abdomen and pelvis done within 7days of admission which shows findings consistent with features of acute pancreatitis. Each component of the BISAP scoring system was studied for each patient in first 24hrs & each component was awarded one point .Organ failure is defined as a score of ≥ 2 in one or >3 organ as originally described in Marshall score. Oragn – failure was described as transient (<48hrs) or persistent (>48hrs) from the time of admission. All the datas were collected & analysed for patients developing organ failure, persistent organ failure, pancreatic necrosis and death. Results: In our study, out of 108nos. of patients, 67(62.1%) were males & 41(37.9%) were females. Alcohol being the leading cause in 57(52.8%) followed by gall stone in 32(29.6%) cases & others in19(17.6%) cases. Patients with BISAP score ≥3 had developed organ failure in 10 (34.4%)cases and with BISAP score ≤ 3 in 6(7.6%) cases. Out of 16nos. organ failure cases 12 cases were transient organ failure & 4cases were persistent organ failure all with BISAP score ≥3. Pancreatic necrosis developed in 18nos of cases of which 11nos with BISAP score ≥3 & 7nos with score ≤ 3. Conclusion: The BISAP score is simple & accurate method for early identification of patients at increased risk of developing organ failure, persistent organ failure, pancreatic necrosis within 24hrs of admission to hospital.
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Objective:To investigate the bedside index for severity in acute pancreatitis(BISAP) score combined with red cell distribution width (red cell distribution width,RDW) on acute pancreatitis (AP) and early assessment of the severity of value.Methods:385 patients with acute pancreatitis were collected from October 2015 to November 2017 in our hospital,according to the severity of the disease were divided into mild group (MAP),moderately severe group (MSAP) and severe group (SAP),patients admitted to hospital within 24h,blood urea nitrogen,blood glucose,blood examination,collection of red blood cells in parallel the BISAP score distribution width,using analysis of variance statistical differences between three groups of data,and draw the RDW combined with BISAP score in predicting the progression of AP receiver operating characteristic curve analysis and its predictive value.Results:Mild group,moderately severe group,severe BISAP score and red blood cell distribution 0width increased sequentially.There was a significant difference in RDW and BISAP scores between the three groups (P＜0.05),and RDW was positively correlated with BISAP score (r=0.384,P＜0.01).The area under the curve of BISAP score,RDW combined with BISAP score for predicting AP disease was 0.879 and 0.894 respectively,and the sensitivity was 77.3％,95.5％,and the specificity was 85.3％ and 76.5％.Conclusion:With the aggravation of AP patients,both the BISAP score and the RDW increase.The combination of the two is helpful to predict the patient's condition.
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Objective To explore the reference value of interleukin(IL)-33 and tumor necrosis factor-alpha(TNF)-α in early diagnosis,illness evaluation and prognosis of acute pancreatitis(AP) by dynamically monitoring the serum levels of IL-33 and TNF-α.Methods A total of 86 patients with AP were selected as objectives which were divided into two groups according the severity of illness which include 59 cases of mild AP group(MAP) and 27 cases of severe AP group(SAP),52 cases of systemic inflammatory response syndrome(SIRS) group and 34 cases of non SIRS group distinguished by SIRS,75 cases of survival group and 11 cases of death group identified by prognosis of AP.All of patients were assessed by Bedside Index of Severity in Acute Pancreatitis(BISAP) score within 48 h after admission and detected the serum levels of IL-33 and TNF-α at the first day,third day,seventh day and fourteenth day during hospital.A total of 63 healthy persons were recruited into control group.Results The serum levels of IL-33,TNF-α and BISAP score of SAP group and MAP group were higher than those of the control group in different monitoring time,but the SAP group increased more obviously than MAP group.The serum levels of IL-33 and TNF-α of SAP group were higher than those of MAP group at the first day,third day,seventh day and fourteenth day during hospital,and the differences between them had statistical significance(P<0.05).The serum levels of IL-33 and TNF-α of SAP group increased to peak at the third day and reduced gradually after conventional treatment(the seventh day in the hospital).The serum levels of IL-33 and TNF-α of SIRS group were significant higher than those of non SIRS group(P<0.05).The serum levels of IL-33,TNF-α and BISAP score of death group were significant higher than those of survival group(P<0.05).Spearman correlation analysis suggested that there were positive correlations between BISAP and the serum levels of IL-33 and TNF-α of AP patients.Conclusion There is an important clinical value to the early diagnosis,severity classification,guiding clinical treatment and the assessment of prognosis of AP by dynamically monitoring the serum levels of IL-33 and TNF-αof AP patients.
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Objective To explore the four criteria,including bedside index for severity in acute pancreatitis(BISAP),Ranson score,modified CT severity index(MCTSI) and acute physiology and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) in assessment of severity and prognosis of hyperlipidemic acute pancreatitis.Methods A total of 326 patients with hyperlipidemic acute pancreatitis were studied retrospectively from August 2006 to July 2015.The discrepancy of the four criteria in assessment of severity and prognosis of hyperlipidemic acute pancreatitis was compared with chi-square test and receiver operating characteristic curve.Results The incidences of moderately severe acute pancreatitis and severe acute pancreatitis,local complications and mortality of patients with BISAP score ≥3,Ranson score ≥3,APACHE Ⅱ score≥8 and MCTSI score≥4 were significantly higher than BISAP score ＜ 3,Ranson score ＜ 3,APACHE Ⅱ score ＜ 8 and MCTSI ＜ 4 respectively (all P ＜ 0.05).As far as severity was concerned,the sensitivity and AUC of APACHE Ⅱ were 57％ and 0.814,which were higher than the other systems.The second most sensitive criterion was BISAP.In assessment of local complications,the sensitivity and AUC of MCTSI were 68％ and 0.791,which were higher than the other three.The most sensitive criterion to predict mortality was BISAP with sensitivity 89％ and AUC 0.867,which was followed by APACHE Ⅱ.Conclusions All four criteria can be used to determine the severity,local complications and mortality.Generally,BISAP is simple and easy to practice,and better than the other three.
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Objective To investigate the value of BISAP scoring system in predicting the severity of acute pancreatitis.Methods Medline,EMBASE,Science Direct,Springer link,CBM,Cnki,Wan fang and VIP database were retrieved by computer between January 2000 and March 2013,and articles of BISAP score system in predicting the acute pancreatitis were collected according to strict inclusion criteria.Quality assessment was made by QUADAS scale.Meta-Disc1.4 software was used to analyze the heterogeneity of included articles and perform quantitative synthesis,as well as calculate the pooled sensitivity and specificity,positive likelihood ratio,negative likelihood ratio,and draw the ROC curve,and the results were presented with 95％ CI.Results A total of 11 articles were included,and there were 7 Chinese articles and 4 English articles.According to QUADAS scale,there were 4 articles of A grade,5 articles of B grade,2 articles of C grade.There were 6 studies using 2 as BISAP cut-off value,and 9 articles using 3 as cut-off value,while 4 studies using 2 cut-off values.Pooled analysis showed diagnostic odds ratio of 8.03 (95 ％ CI 5.66-11.38) when cut-off value was 2,and diagnostic odds ratio of 7.49 (95％ CI 5.35-10.49) when cut-off value was 3.There were moderate heterogeneity in both groups (I2 =63.3 ％,P =0.018; I2 =56.1％,P =0.019).When BISAP cut-off value was 2,the pooled analysis of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and area under curve (AUC) were 59％ (95％ CI56％-63％),82％ (95％ CI 80％-83％),3.50 (95％ CI2.96-4.14),0.45 (95％ CI0.36-0.56) and0.82; and when BISAP cut-off value was 3,the corresponding values were 44％ (95％ CI41％-47％),90％ (95％ CI 89％-91％),4.59 (95％ CI 3.31-6.37),0.64 (95％ CI 0.61-0.68) and 0.64.The former had a high sensitivity,low specificity and large AUC,while the latter had a low sensitivity,high specificity and small AUC.Conclusions The best cut-off value of BISAP in predicting SAP is 2.When cut-off value is 2,the misdiagnosis rate is low,and the false positive rate is in the acceptable range,which is suitable for clinical application.
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Objective To explore the significance of combining coagulation with bedside index for severity in acute pancreatitis (BISAP) scores in evaluation of severity of acute pancreatitis (AP).Methods One hundred and twenty-six patients with AP were diagnosed according to the AP:mild acute pancreatitis (MAP) group of 64 cases,severe acute pancreatitis (SAP) group of 62 cases,and selected 60 healthy persons as control group.AP patients BISAP scores were calculated in 24 h from admission,and the activity of partial thromboplastic time (AFTT),prothrombin time (PT),D-dimer and fibrinogen (FIB) were measured the next morning or after 8 h of fasting peripheral venous blood collected 3 ml.Results There was no significant difference in APTT,PT among three groups (P＞ 0.05).FIB and D-dimer in MAP group and SAP group were significantly higher than those in control group [(4.25 ± 1.01),(5.44 ± 2.19) g/L vs.(3.47 ± 0.49) g/L; (5.08 ± 3.20),(8.65 ± 6.43) mg/L vs.(3.41 ± 2.32) mg/L,P ＜ 0.05],SAP group was significantly higher than that in MAP group(P ＜ 0.05).The positive rate of D-dimer in MAP group was significantly lower than that in SAP group [26.6％(17/64) vs.85.5％ (53/62),P ＜0.01].BISAP scores and combining coagulation with BISAP scores predict the severity of AP AUC were 0.842(0.775-0.889),0.886 (0.839-0.925),there was no statistically significant difference (P ＞0.05).Conclusion The significance of combining coagulation with BISAP scores in the severity of AP is more accurate than only use BISAP scores,and will not increase the clinical application difficulty.