Accuracy of Bisap Score to Predict Severe Acute Pancreatitis Keeping Ranson Score as Gold Standard

Objective: To ascertain the diagnostic accuracy of BISAP score to predict severe acute pancreatitis keeping Ranson score as gold standard Study design: Descriptive Cross Sectional study Place and duration of study: Surgical Department, Combined Military Hospital Rawalpindi from January 2017 to July 2017. Methodology: 65 patients having history indicative of acute pancreatitis, serum lipase and serum amylase were measured. Patients with confirmed diagnosis of acute pancreatitis who consented for taking part in the research and achieving the inclusion and exclusion criteria were enrolled for study. Patients were evaluated by adequate history and thorough examination. All patients are investigated for Ranson score and BISAP score and divided into mild and severe pancreatitis on the basis of BISAPS and Ranson scoring. Results: In our study, mean+sd age was 44.92+8.92 years. Frequency of severe acute pancreatitis was 32.3%. Diagnostic accuracy of BISAP score to predict severe acute pancreatitis keeping Ranson score as gold standard had 80.9% of sensitivity, 81% of specificity, 68% of PPV and 90% of NPV. Conclusion: BISAP score have an excellent accuracy for prediction of severe acute pancreatitis as Ranson score. BISAP score can be used as tool for recognition of severe acute pancreatitis within 24 hours in simple and precise manner. Keywords: Severe acute pancreatitis, Prediction, BISAP score, Ranson score, Accuracy

Soluble B7-H5 Is a Novel Diagnostic, Severity, and Prognosis Marker in Acute Pancreatitis

As an important ligand in T lymphocyte costimulatory pathways, B7-H5 is involved deeply in the immune response in various diseases. However, its clinical usefulness as an early indicator in acute pancreatitis (AP) remains unclear. In this study, the levels of sB7-H5 and cytokines in plasma samples of 75 AP patients, 20 abdominal pain patients without AP, and 20 healthy volunteers were determined. Then, the correlation of sB7-H5 and clinical features, cytokines, the Ranson score, APACHE II score, Marshall score, and BISAP score was analysed, and the value of sB7-H5 for diagnostic, severity, and prognosis of AP was evaluated. We found that the levels of sB7-H5 were specifically upregulated in AP patients. Receiver operating characteristic (ROC) analysis revealed that sB7-H5 can identify AP patients from healthy or abdominal pain patients with 78.9% or 86.4% sensitivity and 93.3% or 90.0% specificity. Further analysis showed that the levels of sB7-H5 were significantly correlated with WBC ( p = 0.004 ), GLU ( p = 0.008 ), LDH ( p < 0.001 ), Ca2+ ( p = 0.006 ), AST ( p = 0.009 ), PLT ( p = 0.041 ), IL-6 ( p < 0.001 ), IL-10 ( p < 0.001 ), and TNF-α ( p < 0.001 ). And levels of sB7-H5 were gradually increased among patients with mildly acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). It can distinguish the severity of AP with good sensitivity and specificity. Moreover, when dividing the patients into two groups according to the median level of sB7-H5, the local complication and length of stay of low levels of the sB7-H5 group were significantly less than those in high levels of the sB7-H5 group. And the levels of sB7-H5 in AP patients were significantly correlated with the Ranson score ( p < 0.001 ), APACHE II score ( p < 0.001 ), Marshall score ( p < 0.001 ), and BISAP score ( p < 0.001 ). The AUCs of assessing local complications of sB7-H5 at day 1 and day 3 were 0.704 ( p = 0.0024 ) and 0.727 ( p = 0.0373 ). These results showed the potential value of sB7-H5 as a diagnostic, severity, and prognosis marker of AP.

D-DIMER - AN ESSENTIAL MARKER IN SEVERITY PREDICTION OF ACUTE PANCREATITIS

Introduction: Acute pancreatitis (AP) is characterized by a spectrum of symptoms, ranging from a local inammatory process to the more severe form (acute necrotizing pancreatitis) which is associated with a systemic inammatory response. The overall mortality rate of AP is between 5% and 15%, reaching 30 % in severe acute pancreatitis (SAP). Early optimized care may improve prognosis in patients with severe forms but it remains a challenge to identify these poor prognosis cases especially in the rst 48 hours. This study will evaluate the efcacy of serum D-Dimer in prediction of severity and outcome of acute pancreatitis. A prospective observati Methods: onal study of 60 patients presenting with AP was done at st st Silchar Medical College from 1 June 2017 to 31 May 2018. APACHE-II, Ranson criteria, and CT severity index (CTSI) of all patients were calculated,. D-Dimer was done for all patients. The patients were stratied into categories of severe pancreatitis, organ failure and pancreatic necrosis, as well as the number of deaths. The comparison of D-Dimer with other scoring systems was done by area under the receiver-operating curve (AUC) to predict severity, organ failure, necrosis, and death. Of the 60 patie Result: nts, 15 (25%) developed SAP, 12 (20%) Organ failure (OF), 22 (36.7%) pancreatic necrosis and 3 (5%) died. ROC curves were generated and following cut-off were selected for comparison of severity, organ failure, necrosis and death; Ranson ≥ 3, APACHE II ≥ 8, CTSI ≥ 4. Cut-off of D-Dimer value for severity, organ failure, necrosis and death are ≥1397µg/L, ≥1886µg/L, ≥1890µg/L and ≥5769µg/L respectively. The AUC of D-Dimer (0.914) in predicting severity of disease is similar to that of Apache 2 (0.958) and Ranson (0.899). CTSI (0.715) had lowest AUC among them. The AUC of D-Dimer (0.833) in predicting of organ failure of disease is similar to that of Ranson (0.908) and lower than Apache 2 (0.980). CTSI (0.715) had lowest AUC among them. The AUC of CTSI (0.892) in predicting the necrosis was higher than Apache 2 (0.590), Ranson score (0.578) system and D-Dimer. The AUC of D-Dimer (0.953) in predicting of mortality of disease is similar to that of Apache 2 (0.933), CTSI (0.953) and lower than Ranson score (0.816). Conclusion: D-Dimer is an easy tool for assessment of severity and prognosis of acute pancreatitis. CTSI is best for predicting pancreatic necrosis.

Bedside index (BISAP) v/s Ranson scores in predicting mortality and severity in patients with acute pancreatitis.

Objective: To determine diagnostic accuracy of BISAP in comparison to Ranson scores in predicting mortalities and severities in patients with acute pancreatitis coming to the emergency department. Methods: Cross-sectional study conducted in Department of Emergency Medicine, Aga Khan University Hospital, Stadium road Karachi, Pakistan. 136 patients were selected via non-probability consecutive sampling technique, those who fulfilled the criteria of inclusion. BISAP score was applied in the emergency department (ED) & the patients were followed in ward/intensive care unit where Ranson scores were calculated in the following 48 hours. Both the scores were calculated and compared for the prediction of severity and mortality for each patient. All the obtained data was recorded in Performa. Results: In this study 136 patients, who fulfill the inclusion criteria were selected. On the basis of BISAP and Ranson score; mild acute pancreatitis to moderate acute pancreatitis (MAP to ModAP) was diagnosed in 123 (90.4%) and 119 (87.5) patients and severe AP (SAP) in 13 (9.6%) and 17 (12.5%) patients respectively. Specificity (Sp) 94.62% vs 91.54%, Sensitivity (Sn) 100.0% vs 100.0%, negative predictive value (NPV) 100.0% vs 100.0%, positive predictive value (PPV) 46.15% vs 35.29% and diagnostic accuracy (DA) 94.85% vs 91.91% of BISAP vs Ranson scores respectively. Conclusion: It was concluded from the study that BISAP and Ranson score are very reliable tool for identification of acute pancreatitis patients at higher risk of severity and mortality. BISAP and Ranson score has same sensitivity but BISAP score has higher specificity than Ranson score. Continuous...

Accuracy of Conventional and Novel Scoring Systems in Predicting Severity and Outcomes in Acute Pancreatitis: A Retrospective Study

Backgroud: Recently there are several novel scoring systems to evaluate the severity and outcomes of acute pancreatitis. This study is to compare the effectiveness of novel and traditional scoring systems for predicting severity and outcomes in acute pancreatitis.Methods: Patients between January 2003 and August 2020 were reviewed. Ranson score (RS), Glasgow score (GS), beside index of severity in acute pancreatitis (BISAP), pancreatic activity scoring system (PASS), and Chinese simple scoring system (CSSS) were determined within 48h after admission. Multivariate logistic regression was used for severity, mortality, and organ failure prediction. Optimum cutoffs were identified using ROC analysis.Results: A total of 1848 patients were included. AUCs of RS, GS, BISAP, PASS, and CSSS for severity prediction were 0.861, 0.865, 0.829, 0.778, and 0.816, respectively. AUCs for mortality prediction were 0.693, 0.736, 0.789, 0.858, and 0.759. AUCs for ARDS prediction were 0.745, 0.784, 0.834, 0.936, and 0.820. AUCs for ARF prediction were 0.707, 0.734, 0.781, 0.868, and 0.816.Conclusions: RS, and GS predict severity superior to mortality and organ failure while PASS predicts mortality and organ failure better. BISAP and CSSS shared steady capacity in severity and outcomes prediction.

The role of Th2 cytokines interleukin-4 and interleukin-5 in assessing severity and prognosis of acute pancreatitis

Introduction/Objective. Acute pancreatitis (AP) is relatively common disease which in most patients has favorable course. However, in approximately 20% patients, the course of the disease is more severe with high mortality (40-50%). The evaluation of disease severity is now primarily based on protocols that includes clinical, laboratory, and radiographic diagnostic procedures, APACHE II score, Ranson score, CT index, and CT necrosis score. Key cells in the immunopathogenesis of AP are T-lymphocytes, and recent studies indicate the role of Th2 and their effector cytokines: interleukin (IL) -4 and: interleukin (IL) -5. The purpose of our study was to determine the potential clinical value of IL-4 and IL-5 as biochemical markers for predicting development of severe, necrotizing form of acute pancreatitis with systemic complication such as systemic inflammatory response syndrome (SIRS). Methods. This prospective study included 240 patients hospitalized at The Clinic for Emergency Surgery of Clinical Center of Serbia as AP. Levels of IL-4 and IL-5 in serum were detected using commercial Bender Med Systems (BMS716FF) kits. Results. IL-4 and IL-5 were statistically significant increased on the second day of hospitalization with maximum values on the third day. In patients with severe AP complicated with necrosis and/or sepsis values were rising all through the seventh day. Conclusion. Levels of IL-4 and IL-5 in peripheral blood correlate with SIRS, Ranson score and clinical outcome in AP patients, therefore these cytokines are potential early biomarkers of disease progression and related complications.

Evaluation of Different Scoring Systems in Predicting the Severity of Acute Pancreatitis

BACKGROUND Accurate prediction of the severity of acute pancreatitis will help in identifying patients at increased risk for morbidity and mortality. We wanted to evaluate the different scoring systems in predicting the severity of acute pancreatitis. METHODS This cross-sectional study was undertaken in the Department of Surgery at a zonal hospital between April 2013 and December 2014. RESULTS 40 patients were selected and enrolled in the study as per the selection criteria. 20 (50 %) patients had fair outcome and 20 (50 %) had a poor outcome. Accuracy of different scoring systems in predicting patient outcome ranged from 45 % (48-hr APACHE II) to 62.5 % (Goris MOF at baseline and 48 hr). Baseline Goris MOF was 70 % sensitive and 55 % specific in prediction of poor outcome. It had an accuracy of 62.5 % in prediction of outcome. 48-hr Goris MOF was 80 % sensitive and 45 % specific in predicting the outcome. Baseline APACHE II scores were below the cut-off level in all the patients. 48-hr APACHE II scores were 5 % sensitive and 100% specific for prediction of outcome. Ranson score > 3 was 25 % sensitive and 90 % specific in the prediction of outcome. Balthazar score > 6 was 65 % sensitive and 55 % specific in prediction of outcome. Ranson score was found to have a limited sensitivity for different outcomes (ranging from 21.1 % to 50 %) but was found to have a high specificity (83.8 % to 90 %). CONCLUSIONS Goris scoring system (at 48 hrs) was found to be highly sensitive to different poor outcomes as well as duration of hospital stay. It also correlated with Balthazar scoring system, which was also highly sensitive to different poor outcomes studied. KEYWORDS Acute Pancreatitis, Prediction, Scoring System, APACHE II, Goris MOF, Ranson’s Score, Balthazar Score

Characteristics of acute pancreatitis with diabetic ketoacidosis and analysis of factors related to the length of hospital stay

Obejective 11% of adults with diabetic ketoacidosis (DKA) also suffer from AP. The obejective of this research was to study the characteristics of AP with DKA, the factors related to the length of hospital stay, and to explore indicators for the severity of AP.Methods A retrospective analysis of 173 AP with DKA cases treated in our hospital from July 2011 to December 2020 was performed. We analyzed the gender, age, systemic inflammatory response syndrome(SIRS), pleural effusion, blood urea nitrogen（BUN）, bedside index for the severity in acute pancreatitis（BISAP）score, white blood cell（WBC）, aspartate transaminase （AST）, lactate dehydrogenase（LDH）, blood glucose, Ranson score, partial pressure of carbon dioxide （PaCO 2 ）,triglyceride, modified CT severity index （MCTSI）, potential of hydrogen potential of hydrogen （PH）, amylase, glycated hemoglobin, C-reactive protein（CRP）, creatinine（Cr）, blood calcium, procalcitonin （PCT）, the length of stay.Result Blood calcium, LDH, BUN, pleural effusion, MCTSI, Ranson score and BISAP score were related to the length of stay (P <0.05). WBC, AST, blood glucose, PaCO 2 , triglyceride, PH, glycated hemoglobin, CRP, Cr , PCT were not related to the length of stay (P> 0.05).Conclusion The current Atlanta classification is not suitable for evaluating the severity of AP with DKA. Serum calcium, LDH, BUN, pleural effusion, and MCTSI are suitable for evaluating the length of stay and severity of AP with DKA.

Intra-Abdominal Pressure, a Prognostic Marker in the Evolution of Acute Pancreatitis

In acute pancreatitis some prognostic scores have been suggested, based on clinical, laboratory and radiological criteria. The most popular are: Ranson score, APACHE II score and CT severity index (CTSI). The trend is to find a prognostic marker that is easy to use, cheap, and reproductible. Recently, the increase of the intra-abdominal pressure (IAP) has drawn attention. Material and Methods: From January 2012 to April 2014, a group of 64 patients, admitted to the Clinical Department of Anaesthesia and Intensive Care and the Surgical Departments of the SCJU Sibiu, with the diagnosis of acute pancreatitis, were included in this observational prospective study. The cut-off values, the specificity and sensitivity of the prognostic scores were calculated using the receiver operating characteristics (ROC) analysis curves. Results: At a cut-off value of 12 mm Hg IAP max has a sensitivity of 0,75, similar to Ranson score at 48 h (0.72 at a cut-off value 3) and CTSI (0,73 at a cut-off value 4). Better results are just for APACHE II score at 24 h (0,88 at a cut-off value 8). IAP max has a specificity of 0,88, simillary to CTSI (0,83) and APACHE II score (0,82). Conclusions: In our study maximum IAP could be correlated with prognostic markers for severe evolution in acute pancreatitis.

The correlation of JKAP with risk, severity, inflammation and in-hospital mortality of severe acute pancreatitis

Background This study aimed to investigate the predictive value of JNK pathway-associated phosphatase (JKAP) level for severe acute pancreatitis (SAP) risk, and its association with disease severity, inflammation and in-hospital mortality in SAP patients. Methods Our study recruited 50 SAP patients, 50 moderate-severe acute pancreatitis (MSAP) patients, 50 mild acute pancreatitis (MAP) patients and 50 healthy controls. And the serum samples were obtained from all acute pancreatitis patients within 24 hours after admission and from health controls at their enrollment to detect JKAP level by enzyme-linked immunosorbent assay. Results JKAP level was decreased in SAP patients compared with healthy controls, MSAP and MAP patients. And receiver operating characteristics (ROC) curve analysis revealed that JKAP could not only distinguish SAP patients from healthy controls (AUC: 0.914, 95%CI: 0.857-0.971), but also differentiate SAP patients from MAP patients (AUC: 0.869, 95%CI: 0.802-0.937) and MSAP patients (AUC: 0.712, 95%CI: 0.610-0.813). In SAP patients, JKAP was negatively correlated with Ranson score, acute physiology and chronic health care evaluation II (APACEH II) score, sequential organ failure assessment (SOFA) score and C-reactive protein (CRP). And lower JKAP level, higher CRP level, Ranson score, APACEH II score and SOFA score were associated with increased in-hospital mortality in SAP patients. Additionally, ROC curve analysis showed that JKAP could predict decreased in-hospital mortality in SAP patients (AUC: 0.720, 95%CI: 0.526-0.914). Conclusions JKAP might serve as a biomarker for disease risk and management for SAP.