Bedside Index For Severity in Acute Pancreatitis and Assessing Morbidity and Mortality : A Prospective Study

ABSTRACT

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.