DOI QR코드

DOI QR Code

A comparison of the BISAP score and serum procalcitonin for predicting the severity of acute pancreatitis

  • Kim, Byung Geun (Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Noh, Myung Hwan (Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Ryu, Choong Heon (Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Nam, Hwa Seong (Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Woo, Su Mi (Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Ryu, Seung Hee (Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Jang, Jin Seok (Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Lee, Jong Hun (Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Choi, Seok Ryeol (Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Park, Byeong Ho (Department of Radiology, Dong-A University College of Medicine)
  • Published : 2013.05.01

Abstract

Background/Aims: The bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactorial scoring system. As more data are needed before clinical application, we compared BISAP, the serum procalcitonin (PCT), and other multifactorial scoring systems simultaneously. Methods: Fifty consecutive acute pancreatitis patients were enrolled prospectively. Blood samples were obtained at admission and after 48 hours and imaging studies were performed within 48 hours of admission. The BISAP score was compared with the serum PCT, Ranson's score, and the acute physiology and chronic health examination (APACHE)-II, Glasgow, and Balthazar computed tomography severity index (BCTSI) scores. Acute pancreatitis was graded using the Atlanta criteria. The predictive accuracy of the scoring systems was measured using the area under the receiver-operating curve (AUC). Results: The accuracy of BISAP (${\geq}2$) at predicting severe acute pancreatitis was 84% and was superior to the serum PCT (${\geq}3.29ng/mL$, 76%) which was similar to the APACHE-II score. The best cutoff value of BISAP was 2 (AUC, 0.873; 95% confidence interval, 0.770 to 0.976; p < 0.001). In logistic regression analysis, BISAP had greater statistical significance than serum PCT. Conclusions: BISAP is more accurate for predicting the severity of acute pancreatitis than the serum PCT, APACHE-II, Glasgow, and BCTSI scores.

Keywords

References

  1. Triester SL, Kowdley KV. Prognostic factors in acute pancreatitis. J Clin Gastroenterol 2002;34:167-176. https://doi.org/10.1097/00004836-200202000-00014
  2. Lee SK. Medical treatments of necrotizing pancreatitis. Korean J Med 2007;73:237-242.
  3. Kusske AM, Rongione AJ, Reber HA. Cytokines and acute pancreatitis. Gastroenterology 1996;110:639-642. https://doi.org/10.1053/gast.1996.v110.agast960639
  4. Larvin M. Circulating mediators in acute pancreatitis as predictors of severity. Scand J Gastroenterol Suppl 1996;219:16-19.
  5. Windsor AC, Kanwar S, Li AG, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 1998;42:431-435. https://doi.org/10.1136/gut.42.3.431
  6. Ranson JH, Pasternack BS. Statistical methods for quantifying the severity of clinical acute pancreatitis. J Surg Res 1977;22:79-91. https://doi.org/10.1016/0022-4804(77)90045-2
  7. Yeung YP, Lam BY, Yip AW. APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis. Hepatobiliary Pancreat Dis Int 2006;5:294-299.
  8. Larvin M, McMahon MJ. APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet 1989;2:201-205.
  9. Wilson C, Heath DI, Imrie CW. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg 1990;77:1260-1264. https://doi.org/10.1002/bjs.1800771120
  10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829. https://doi.org/10.1097/00003246-198510000-00009
  11. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology 1990;174:331-336. https://doi.org/10.1148/radiology.174.2.2296641
  12. Gurda-Duda A, Kusnierz-Cabala B, Nowak W, Naskalski JW, Kulig J. Assessment of the prognostic value of certain acute-phase proteins and procalcitonin in the prognosis of acute pancreatitis. Pancreas 2008;37:449-453. https://doi.org/10.1097/MPA.0b013e3181706d67
  13. Modrau IS, Floyd AK, Thorlacius-Ussing O. The clinical value of procalcitonin in early assessment of acute pancreatitis. Am J Gastroenterol 2005;100:1593-1597. https://doi.org/10.1111/j.1572-0241.2005.41456.x
  14. Kylanpaa-Back ML, Takala A, Kemppainen E, Puolakkainen P, Haapiainen R, Repo H. Procalcitonin strip test in the early detection of severe acute pancreatitis. Br J Surg 2001;88:222-227. https://doi.org/10.1046/j.1365-2168.2001.01673.x
  15. Ammori BJ, Becker KL, Kite P, et al. Calcitonin precursors in the prediction of severity of acute pancreatitis on the day of admission. Br J Surg 2003;90:197-204. https://doi.org/10.1002/bjs.4036
  16. Woo SM, Noh MH, Kim BG, et al. Comparison of serum procalcitonin with Ranson, APACHE-II, Glasgow and Balthazar CT severity index scores in predicting severity of acute pancreatitis. Korean J Gastroenterol 2011;58:31-37. https://doi.org/10.4166/kjg.2011.58.1.31
  17. Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut 2008;57:1698-1703. https://doi.org/10.1136/gut.2008.152702
  18. Singh VK, Wu BU, Bollen TL, et al. A prospective evaluation of the bedside index for severity in acute pancreatitis score in assessing mortality and intermediate markers of severity in acute pancreatitis. Am J Gastroenterol 2009;104:966-971. https://doi.org/10.1038/ajg.2009.28
  19. Buter A, Imrie CW, Carter CR, Evans S, McKay CJ. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg 2002;89:298-302. https://doi.org/10.1046/j.0007-1323.2001.02025.x
  20. Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inf lammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg 2006;93:738-744. https://doi.org/10.1002/bjs.5290
  21. Papachristou GI, Muddana V, Yadav D, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol 2010;105:435-441. https://doi.org/10.1038/ajg.2009.622
  22. Toouli J, Brooke-Smith M, Bassi C, et al. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol 2002;17 Suppl:S15-S39. https://doi.org/10.1046/j.1440-1746.17.s1.2.x
  23. Bradley EL 3rd. A clinically based classification system for acute pancreatitis: summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993;128:586-590. https://doi.org/10.1001/archsurg.1993.01420170122019
  24. Villatoro E, Mulla M, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev 2010;(5):CD002941.
  25. Servin-Torres E, Velazquez-Garcia JA, Delgadillo-Teyer G, Galindo-Mendoza L, Bevia-Perez F, Rivera-Bennet F. Severe acute pancreatitis: surgical management in a third-level hospital. Cir Cir 2009;77:407-410.
  26. Dervenis C, Bassi C. Evidence-based assessment of severity and management of acute pancreatitis. Br J Surg 2000;87:257-258. https://doi.org/10.1046/j.1365-2168.2000.01348.x
  27. Lempinen M, Puolakkainen P, Kemppainen E. Clinical value of severity markers in acute pancreatitis. Scand J Surg 2005;94:118-123.
  28. Wyncoll DL. The management of severe acute necrotising pancreatitis: an evidence-based review of the literature. Intensive Care Med 1999;25:146-156. https://doi.org/10.1007/s001340050808
  29. Neoptolemos JP, Kemppainen EA, Mayer JM, et al. Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. Lancet 2000;355:1955-1960. https://doi.org/10.1016/S0140-6736(00)02327-8
  30. Muller CA, Uhl W, Printzen G, et al. Role of procalcitonin and granulocyte colony stimulating factor in the early prediction of infected necrosis in severe acute pancreatitis. Gut 2000;46:233-238. https://doi.org/10.1136/gut.46.2.233
  31. Puolakkainen P, Valtonen V, Paananen A, Schroder T. C-reactive protein (CRP) and serum phospholipase A2 in the assessment of the severity of acute pancreatitis. Gut 1987;28:764-771. https://doi.org/10.1136/gut.28.6.764
  32. Wilson C, Heads A, Shenkin A, Imrie CW. C-reactive protein, antiproteases and complement factors as objective markers of severity in acute pancreatitis. Br J Surg 1989;76:177-181. https://doi.org/10.1002/bjs.1800760224
  33. Chen CC, Wang SS, Lee FY, Chang FY, Lee SD. Proinf lammatory cytokines in early assessment of the prognosis of acute pancreatitis. Am J Gastroenterol 1999;94:213-218. https://doi.org/10.1111/j.1572-0241.1999.00709.x
  34. Kylanpaa-Back ML, Takala A, Kemppainen EA, et al. Procalcitonin, soluble interleukin-2 receptor, and soluble E-selectin in predicting the severity of acute pancreatitis. Crit Care Med 2001;29:63-69. https://doi.org/10.1097/00003246-200101000-00016
  35. Ammori BJ, Becker KL, Kite P, et al. Calcitonin precursors: early markers of gut barrier dysfunction in patients with acute pancreatitis. Pancreas 2003;27:239-243. https://doi.org/10.1097/00006676-200310000-00008
  36. Mofidi R, Suttie SA, Patil PV, Ogston S, Parks RW. The value of procalcitonin at predicting the severity of acute pancreatitis and development of infected pancreatic necrosis: systematic review. Surgery 2009;146:72-81. https://doi.org/10.1016/j.surg.2009.02.013

Cited by

  1. The Value of BISAP Score for Predicting Mortality and Severity in Acute Pancreatitis: A Systematic Review and Meta-Analysis vol.10, pp.6, 2013, https://doi.org/10.1371/journal.pone.0130412
  2. Acute Pancreatitis—Progress and Challenges: A Report on an International Symposium vol.44, pp.8, 2015, https://doi.org/10.1097/mpa.0000000000000500
  3. Evaluating the Ability of the Bedside Index for Severity of Acute Pancreatitis Score to Predict Severe Acute Pancreatitis: A Meta-Analysis vol.25, pp.2, 2013, https://doi.org/10.1159/000441003
  4. Predicting morbidity and mortality in acute pancreatitis in an Indian population: a comparative study of the BISAP score, Ranson’s score and CT severity index vol.4, pp.3, 2013, https://doi.org/10.1093/gastro/gov009
  5. Early warning score independently predicts adverse outcome and mortality in patients with acute pancreatitis vol.402, pp.5, 2013, https://doi.org/10.1007/s00423-017-1581-x
  6. The Bedside Index for Severity in Acute Pancreatitis: a systematic review of prospective studies to determine predictive performance vol.7, pp.4, 2013, https://doi.org/10.1080/20009666.2017.1361292
  7. Inflammatory mediators in the diagnosis and treatment of acute pancreatitis: pentraxin-3, procalcitonin and myeloperoxidase vol.14, pp.2, 2013, https://doi.org/10.5114/aoms.2016.57886
  8. Comparative Evaluation of the BISAP Score with CT Severity Index in Predicting the Severity of Acute Pancreatitis vol.80, pp.4, 2013, https://doi.org/10.1007/s12262-017-1609-z
  9. Machine Learning Models of Acute Kidney Injury Prediction in Acute Pancreatitis Patients vol.2020, pp.None, 2020, https://doi.org/10.1155/2020/3431290
  10. Characteristics of inflammatory factors and lymphocyte subsets in patients with severe COVID‐19 vol.92, pp.11, 2013, https://doi.org/10.1002/jmv.26070