scholarly journals Comparison of BISAP score with Ranson’s score in predicting severe acute pancreatitis

2016 ◽  
Vol 18 (3) ◽  
pp. 44
Author(s):  
D Karki ◽  
T Tamang ◽  
D Maharjan ◽  
P Thapa ◽  
S Shrestha
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Scoring System ◽  
Laboratory Data ◽  
P Value ◽  
Severe Pancreatitis ◽  
Common Etiology ◽  
Sensitivity Specificity

Objectives: To compare BISAP score with Ranson’s scoring in predicting severity of acute pancreatitisMethods: Extensive demographic, radiographic, and laboratory data from consecutive patients with AP admitted to our institution was collected between March 2014 to March 2015. Ranson’s and BISAP score was calculated. Severity of pancreatitis was defined according to Atlanta classification. Sensitivity, Specificity, PPV, NPV of both the scoring system was calculated and compared.Results: A total of 42 patients with diagnosis of acute pancreatitis were included during the study period. 21(50%) were male and 21(50%) were female. Mean age is 49.52 ± 17.37.Most common etiology was biliary (45%) followed by alcohol (31%). 20 (48%) patients were categorized as severe pancreatitis according to Atlanta classification. 21 (50%) patients had a Ranson’s score of ≥3 and 19 (45.24%) patients had a BISAP score of ≥3. Both Ranson’s and BISAP scoring system was statistically significant in determining SAP ( p-value = 0.002). Sensitivity, specificity, PPV and NPV of Ranson’s and BISAP score was calculated to be 75%, 72.72%, 71.43%, 76.19% and 70%, 77.27%, 73.68%, 73.91%. respectively. The AUC for SAP by Ranson’s score is 0.7386 ; 95%CI (0.602 - 0.874) and BISAP score is 0.7364 ; 95% CI ( 0.599 - 0.872).Conclusions: Both Ranson’s and BISAP scoring system is similar in predicting SAP. However BISAP has the advantage due to its simplicity.

scholarly journals Early identification of patient at risk of acute severe pancreatitis with systemic inflammatory response

2016 ◽  
Vol 18 (3) ◽  
pp. 25
Author(s):  
U Laudari ◽  
TP Parajuli ◽  
A Parajuli ◽  
SR Rupakheti ◽  
MR Joshi
Keyword(s):  
Acute Pancreatitis ◽  
Inflammatory Response ◽  
Predictive Value ◽  
Systemic Inflammatory Response ◽  
P Value ◽  
Imaging Data ◽  
Severe Pancreatitis ◽  
Blood Leukocyte ◽  
Sensitivity Specificity ◽  
Patient At Risk

Introduction and Objective: Clinically, the Systemic Inflammatory Response Syndrome (SIRS) is identified by two or more symptoms including fever or hypothermia, tachycardia, tachypnoea and change in blood leukocyte count. The relationship between SIRS symptoms at the time of presentation and severity of pancreatitis is yet to be determined though progression of SIRS in subsequent days has been already correlated. The aim our study was to determine the severity of pancreatitis with SIRS score at the time of admission.Materials and Methods: We conducted prospective cohort study of consecutive patient admitted to emergency of KMCTH, with diagnosis of Acute Pancreatitis (AP) from December 2014 to January 2016. Clinical, biochemical and imaging data from the patients were collected to diagnose pancreatitis. Acute Pancreatitis was diagnosed as per Revised Atlanta Classification 2012. SIRS was evaluated at the time of admission and was correlated with Modified Marshall scoring system for organ dysfunction and sensitivity, specificity and predictive value of SIRS score at admission for organ failure was calculated.Results: Among 41 patients admitted with diagnosis of Acute pancreatitis irrespective of cause the sensitivity of SIRS score at admission in predicting Severe pancreatitis was 28 %, specificity was 80%, Positive predictive value was 60 % and NPV was 51 %, with P value of 0.52 and odds ratio of 1.6 ( CI- 0.376-6.808).Conclusion: This study showed that SIRS score at admission is not sensitive in predicting severe pancreatitis however it is specific for severe pancreatitis.

scholarly journals Comparison between Ransons score and modified CTSI in predicting the severity of acute pancreatitis based on modified Atlanta classification 2012

2019 ◽  
Vol 6 (5) ◽  
pp. 1596
Author(s):  
Manjunath B. D. ◽  
Mohammed Arafath Ali ◽  
Abdul Razack ◽  
Harindranath H. R. ◽  
Avinash K. ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Severe Disease ◽  
P Value ◽  
Early Assessment ◽  
Idiopathic Pancreatitis ◽  
Severe Pancreatitis ◽  
Gall Stones ◽  
Patients At Risk ◽  
Multiorgan Dysfunction Syndrome

Background: Acute pancreatitis is an inflammatory process of the pancreas with possible peripancreatic tissue and multiorgan involvement inducing multiorgan dysfunction syndrome (MODS) with a high mortality rateand hence early identification of patients at risk for severe disease is of vital importance.Methods: Data were collected from 50 patients who presented to the emergency department of hospitals attached to BMCRI, Bangalore, having acute pancreatitis.Results: The study included 50 patients- 40 males and 10 females and median patient age was 54.5years.Out of the 50 patients, 40% had gall stones, 56% were alcoholic and 4% had idiopathic pancreatitis.56% were found to have a Ransons score of >3 and 44% had score < 3; 52%had a modified CTSI score of 0-2, 52%had a score of 4-6 and 22% had a score of 8-10. The incidence of severe acute pancreatitis in patients with Ransons score >3 has a p value <0.002. Also, the incidence of severe acute pancreatitis in patients with modified CTSI score >4 has a p value of <0.001.With respect to mortality, all 4 patients who died had a modified CTSI score of >4 (p=0.002) and 3 patients had Ransons score >3 (p=0.03) which is statistically significant.Conclusions: In our country where facility for CECT is not available to a major proportion of population, early assessment of severe pancreatitis can be performed by Ransons scoring, which is found to be comparable to modified CTSI scoring.

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

2020 ◽  
Vol 7 (5) ◽  
pp. 1473
Author(s):  
Amulya Aggarwal ◽  
Alok V. Mathur ◽  
Ram K. Verma ◽  
Megha Gupta ◽  
Dheeraj Raj
Keyword(s):  
Acute Pancreatitis ◽  
Likelihood Ratio ◽  
Sensitivity And Specificity ◽  
Severe Acute Pancreatitis ◽  
Predictive Value ◽  
Scoring System ◽  
Treatment Protocol ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Clinical Scoring

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.

scholarly journals Early identification of patients at risk of acute severe pancreatitis with Systemic Inflammatory Response Syndrome score at admission

2019 ◽  
Vol 8 (2) ◽  
pp. 92-95
Author(s):  
Uttam Laudari ◽  
Abishek Thapa ◽  
Tanka Prasad Bohara ◽  
Shail Rupakheti ◽  
Mukund Raj Joshi
Keyword(s):  
Acute Pancreatitis ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Predictive Value ◽  
College Teaching ◽  
Systemic Inflammatory Response ◽  
P Value ◽  
Predictive Values ◽  
Acute Severe Pancreatitis ◽  
Severe Pancreatitis

Background: Clinically, the Systemic Inflammatory Response Syndrome (SIRS) is identified by two or more symptoms including fever or hypothermia, tachycardia, tachypnea and change in blood leukocyte count. The relationship between SIRS symptoms at the time of presentation and severity of pancreatitis is yet to be determined though progression of SIRS in subsequent days has already been correlated.Objectives: To determine the severity of pancreatitis with SIRS score at the time of admission.Methodology: A retrospective cohort study of patients admitted to Department of Surgery, Kathmandu Medical College Teaching Hospital (KMCTH) with diagnosis of Acute Pancreatitis (AP) from December 2014 to January 2016 was conducted. Clinical, biochemical and imaging data were collected from the medical record section. Patients with diagnosis of acute pancreatitis as per Revised Atlanta Classification 2012 were included in the study. SIRS score at time of admission was correlated with Modified Marshall scoring system for organ dysfunction. Patients were grouped into severe and nonsevere group. Sensitivity, specificity and predictive values of SIRS score at admission for organ failure were calculated.Results: Among the 41 patients admitted with diagnosis of acute pancreatitis irrespective of cause, the sensitivity of SIRS score ≥2 at admission in predicting severe pancreatitis was 60 %, specificity was 20%, positive predictive value was 28% and negative predictive value was 20 %, with p-value of 0.52 and odds ratio of 1.6 (CI: 0.376-6.808).Conclusion: SIRS score at admission cannot be solely used in predicting acute severe pancreatitis. Patients can be stratified in resource deficit setting for timely referral to tertiary centre.

scholarly journals Ringer’s Lactate Prevents Early Organ Failure by Providing Extracellular Calcium

2020 ◽  
Vol 9 (1) ◽  
pp. 263 ◽  
Author(s):  
Biswajit Khatua ◽  
Jordan R. Yaron ◽  
Bara El-Kurdi ◽  
Sergiy Kostenko ◽  
Georgios I. Papachristou ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Severe Acute Pancreatitis ◽  
Systemic Inflammation ◽  
Normal Saline ◽  
Meta Analysis ◽  
Extracellular Calcium ◽  
Severe Pancreatitis ◽  
Ringer’S Lactate

Objective: Ringer’s lactate may improve early systemic inflammation during critical illnesses like severe acute pancreatitis, which are associated with hypocalcemia. Ringer’s lactate is buffered and contains lactate and calcium. We, thus analyzed extracellular calcium or lactate’s effects on the mechanisms, intermediary markers, and organ failure in models mimicking human disease with nonesterified fatty acid (NEFA) elevation. Methods: Meta-analyses and experimental studies were performed. Experimentally, extracellular calcium and lactate were compared in their interaction with linoleic acid (LA; a NEFA increased in human severe pancreatitis), and its subsequent effects on mitochondrial depolarization and cytosolic calcium signaling resulting in cell injury. In vivo, the effect of LA was studied on organ failure, along with the effect of calcium or lactate (pH 7.4) on severe acute pancreatitis-associated organ failure. A meta-analysis of human randomized control trials comparing Ringer’s lactate to normal saline was done, focusing on necrosis and organ failure. Results: Calcium reacted ionically with LA and reduced lipotoxic necrosis. In vivo, LA induced organ failure and hypocalcemia. During severe pancreatitis, calcium supplementation in saline pH 7.4, unlike lactate, prevented hypocalcemia, increased NEFA saponification, reduced circulating NEFA and C-reactive protein, reduced pancreatic necrosis adjacent to fat necrosis, and normalized shock (carotid pulse distension) and blood urea nitrogen elevation on day 1. This, however, did not prevent the later increase in serum NEFA which caused delayed organ failure. Meta-analysis showed Ringer’s lactate reduced necrosis, but not organ failure, compared with normal saline. Conclusion: Hypocalcemia occurs due to excess NEFA binding calcium during a critical illness. Ringer’s lactate’s early benefits in systemic inflammation are by the calcium it provides reacting ionically with NEFA. This, however, does not prevent later organ failure from sustained NEFA generation. Future studies comparing calcium supplemented saline resuscitation to Ringer’s lactate may provide insights to this pathophysiology.

ID: 36: PEGASPARGASE INDUCED SEVERE PANCREATITIS. FRIEND OR FOE?

2016 ◽  
Vol 64 (4) ◽  
pp. 942.1-942 ◽  
Author(s):  
N Vyas ◽  
H Alkhawam ◽  
R Sogomonian ◽  
RA Ching Companioni ◽  
M Tiba ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Severe Acute Pancreatitis ◽  
Lymphoblastic Leukemia ◽  
Kidney Injury ◽  
Leukemic Cells ◽  
Drug Induced ◽  
Severe Pancreatitis ◽  
Elevated Liver Enzymes ◽  
Wide Range

IntroductionPegaspargase (Oncaspar) is a modified version of L-asparaginase conjugated with polyethylene glycol. In leukemic cells, asparaginase hydrolyzes L- asparagine to ammonia and L-aspartic acid leading to depletion of asparagine. Despite its potential benefits there are a wide range of side effects. One rare but potentially deadly complication is severe pancreatitis.CaseThe patient was a 24 year old Mexican male with a history of Acute T-Cell Lymphoblastic Leukemia (ALL) on recent chemotherapy including pegaspargase, admitted for abdominal pain, found to have acute pancreatitis secondary to hypertriglyceridemia. Heart rate was 127 bpm, chest revealed decreased air entry in right lung bases, and a distended severely tender abdomen. Laboratory tests were remarkable for elevated liver enzymes ALP 360 U/L, AST 310 U/L, GGT 216 U/L, ALT 44 U/L, LDH 829 U/L, elevated lipase 228 U/L, and hypertriglyceridemia >3,000 mg/dL. Abdominal CT showed pancreatitis with necrosis; peripancreatic, intraperitoneal and extensive retroperitoneal fluid. Subsequently his severe pancreatitis was associated with acute kidney injury and respiratory failure which is illustrated by his (BUN 22 Creatinine 2.16, and persistent hypoxia.) According to the Atlanta Classification, patient is classified under severe acute pancreatitis.DiscussionPegaspargase is used for treatment of ALL and is gaining in popularity over Asparaginase therapy due to it having fewer incidences of hypersensitivity reactions and because of its long half life (367 hrs) allowing dosing every 14 days as opposed to Asparaginase which is dosed daily. Pegaspargase definitely has its benefits but we can't lose sight of one of its rare, but potentially deadly complications, pancreatitis. In one study nine of the 50 patients (18%) with ALL treated with pegaspargase were diagnosed to have pancreatitis. In contrast, only one out of 52 (1.9%) ALL patients who received native E. coli L-asparaginase during the same time period developed pancreatitis. One proposed mechanism of this drug-induced pancreatitis is hypertriglyceridemia, which is seen in our case. It is suggested that apolipoprotein E polymorphism may influence the development of hyperlipidemia in ALL patients receiving pegaspargase therapy.We report a case to increase the awareness of higher incidence of pegaspargase-induced pancreatitis, which is a rare but potentially deadly complication. Clinicians should monitor triglycerides while on treatment and suspect pancreatitis if patient develops abdominal pain. If pancreatitis occurs, therapy should be stopped and not reinstituted. For patients with hypertriglyceridemia without pancreatitis discontinuation of therapy should be considered.Abstract ID: 36 Figure 1Impression: Severe acute pancreatitis. Significant interval worsening.

scholarly journals Harmless Acute Pancreatitis Score

2022 ◽  
Vol 19 (1) ◽  
pp. 47-50
Author(s):  
Shiv Vansh Bharti ◽  
Anup Sharma
Keyword(s):  
Acute Pancreatitis ◽  
Scoring System ◽  
Poor Prognosis ◽  
Severe Disease ◽  
Cross Sectional Study ◽  
Common Disease ◽  
Intensive Care Unit Care ◽  
Close Monitoring ◽  
Cross Sectional ◽  
Severe Pancreatitis

Introduction: Acute Pancreatitis is a common disease in our region. It can range from mild to severe disease with high mortality rate. It is critical to identify patients who are at high risk for a severe disease course, since they require close monitoring and immediate aggressive treatment. Aims: To compare the effectiveness of Harmless Acute Pancreatitis Score with Ranson’s scoring system in predicting the severity of Acute Pancreatitis. Methods: A prospective cross sectional study was done among 45 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. If haematocrit was less than39% in female and less than43% in male, serum creatinine less than two miligram /deciliter and no sign of peritonitis, it was assigned as Harmless Acute Pancreatitis Score Zero. If at least one parameter was abnormal it was assigned as Harmless Acute Pancreatitis Score +. Severe pancreatitis (poor prognosis) was considered in those who required Intensive Care Unit care, who had in hospital mortality and who had hospitalization of more than five days. Patients with on admission Ranson’s score of more than three were suspected to have severe Pancreatitis. Results: There were total 45 patients, 18 females and 27 males. Twenty four patients were assigned as Harmless Acute Pancreatitis Score zero and 21 patients were assigned as Harmless Acute Pancreatitis Score +. Harmless Acute Pancreatitis Score was able to predict correctly in 18 out of 26 patients who fulfilled the criteria of poor prognosis (p<0.001). Conclusion: Harmless Acute Pancreatitis Score proved to be a better screening tool compared to on admission Ranson’s scoring system to predict the severity of Acute Pancreatitis, which may help predict the prognosis of the patient.

scholarly journals Colonic Necrosis in a 4-Year-Old with Hyperlipidemic Acute Pancreatitis

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Tiffany J. Patton ◽  
Timothy A. Sentongo ◽  
Grace Z. Mak ◽  
Stacy A. Kahn
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Pseudocyst ◽  
Fluid Collection ◽  
Initial Presentation ◽  
Metabolic Abnormalities ◽  
Pediatric Case ◽  
Severe Pancreatitis ◽  
Colonic Necrosis

Here we report the case of a 4-year-old male with severe acute pancreatitis due to hyperlipidemia, who presented with abdominal pain, metabolic abnormalities, and colonic necrosis. This colonic complication was secondary to the extension of a large peripancreatic fluid collection causing direct serosal autodigestion by pancreatic enzymes. Two weeks following the initial presentation, the peripancreatic fluid collection developed into a mature pancreatic pseudocyst, which was percutaneously drained. To our knowledge, this is the youngest documented pediatric case of colonic necrosis due to severe pancreatitis and the first descriptive pediatric case of a colonic complication due to hyperlipidemia-induced acute pancreatitis.

Sign in / Sign up

Export Citation Format

Share Document