Early diagnosis and severity assessment of acute pancreatitis (AP) using MR elastography (MRE) with spin-echo echo-planar imaging.

Bedside index for severity in acute pancreatitis: comparison with other scoring systems in predicting severity and organ failure

Background/AimsThe 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.MethodsFifty 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).ResultsThe accuracy of BISAP (≥ 2) at predicting severe acute pancreatitis was 84% and was superior to the serum PCT (≥ 3.29 ng/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.ConclusionsBISAP is more accurate for predicting the severity of acute pancreatitis than the serum PCT, APACHE-II, Glasgow, and BCTSI scores.

The bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactor scoring system. As there were no studies designed to validate this system according to the latest Atlanta classification in China and more data are needed before clinical application, we compared BISAP, the Acute Physiology and Chronic Health Evaluation (APACHE) II and Ranson scoring systems in predicting the severity, pancreatic necrosis and mortality of acute pancreatitis (AP) using the latest 2012 Atlanta classification in a tertiary care center in China. The medical records of all patients with AP admitted to our hospitals between January 2010 and June 2013 were reviewed retrospectively. Severe AP was defined as the persistence of organ failure for more than 48 h. The capacity of the BISAP, APACHE II and Ranson's score system to predict severity, pancreatic necrosis and mortality was evaluated using linear-by-linear association. The predictive accuracy of the BISAP, APACHE II and Ranson's score was measured as the area under the receiver operating characteristic curve (AUC). Of 155 patients enrolled in the study, 16.7% were classified as having severe AP, and six (3.2%) died. There were statistically significant trends for increasing severity (P < 0.001), PNec (P < 0.001) and mortality (P < 0.001) with increasing BISAP. The AUC for severity predicted by BISAP was 0.793 (95% confidence interval [CI] 0.700-0.886), APACHE II 0.836 (95% CI 0.744-0.928) and by Ranson score was 0.903 (95% CI 0.814-0.992). The AUC for PNec predicted by BISAP was 0.834 (95% CI 0.739-0.929), APACHE II 0.801 (95% CI 0.691-0.910) and by Ranson score was 0.840 (95% CI 0.741-0.939). The AUC for mortality predicted by BISAP was 0.791 (95% CI 0.593-0.989), APACHE II 0.812 (95% CI 0.717-0.906) and by Ranson score was 0.904 (95% CI 0.829-0.979). BISAP score may be a valuable source for risk stratification and prognostic prediction in Chinese patients with AP. A prospective and multicenter validation study is required to confirm our results and further our recognition of BISAP scores in AP.

Introduction: Acute pancreatitis (AP) is a significant abdominal emergency characterized by inflammation of the pancreas, primarily due to autodigestion by pancreatic enzymes. Early severity assessment is crucial for management, as severe cases lead to complications and mortality. While various scoring systems exist, the Bedside Index for Severity in Acute Pancreatitis (BISAP) and APACHE-II (Acute Physiology and Chronic Health Evaluation) scores are commonly used, each with unique advantages and limitations in severity prediction. Objective: This study aims to compare the effectiveness of BISAP and APACHE-II scores in predicting acute pancreatitis severity, helping clinicians optimize treatment decisions. Methods: This observational study was conducted at SMS Hospital, Jaipur, involving 76 patients diagnosed with AP based on clinical, biochemical, and imaging criteria. Participants were assessed using both BISAP and APACHE-II scoring within 24 hours of admission, with a focus on accuracy in predicting severe cases and outcomes. Results: Among participants, the mean age was 43 years, and 84.2% were male. Gallstone disease was the leading cause of AP (55.2%), followed by alcohol (34.2%). BISAP scores ≥3 was associated with significantly higher mortality, highlighting BISAP’s predictive accuracy. The mean BISAP score was 1.86 ± 1.09, while the APACHE-II score was 6.97 ± 5.66, indicating more severe classifications using BISAP. The study found a moderate positive correlation between BISAP and APACHE-II scores, though only BISAP scores significantly predicted patient outcomes. Conclusion: BISAP offers a rapid and accurate assessment tool for AP severity, especially suitable for early intervention in high-risk patients. Compared to APACHE-II, BISAP is simpler, cost-effective, and demonstrates a high negative predictive value, making it more practical for acute settings.

BISAP-eGFR could improve prediction of severity and mortality in acute pancreatitis. eGFR ? play the trump card.

Background: There are many multifactorial scoring systems, radiological scores and biochemical markers available for early prediction of severity and mortality in patients with acute pancreatitis(AP). The bedside index for severity in acute pancreatitis (BISAP) Score has been considered as an accurate method of risk stratification in patients with acute pancreatitis. Objective: To assess and classify patients with acute pancreatitis according to bedside index for severity in acute pancreatitis (BISAP) Score and to corelate the prognosis of the patients with the BISAP score. Methodology: Records of patients who are admitted with acute pancreatitis in Mandya Institute of Medical Sciences, Mandya between January 2018 and December 2019 (2 year period) was studied, 152 acute pancreatitis cases were admitted during this period. All the cases records were analysed. Those diagnosed with acute pancreatitis on the basis of epigastric pain, serum amylase and serum lipase levels more than 3 times normal were subjected to investigations for BISAP scoring. BISAP score was calculated at 24 hours. A score of > 3 was used to label severe acute pancreatitis(SAP) according to the scoring system. Statistical analysis was made using the student t test and chi-square test and statistical significance was analysed. Results: In our study Out of 152 patients, 26% had severe acute pancreatitis. Acute Pancreatitis was seen in male (78%), in 4th decade (65%), alcohol was the most common aetiology (52%), followed by biliary pancreatitis (33%), remaining idiopathic (15%). Patients with BISAP >= 3 was associated with transient or persistent organ failure and pancreatic necrosis. Accuracy to predict SAP by BISAP score was 63.3 %, on the basis of sensitivity. Conclusion: BISAP score is a valuable tool in classifying patients of Acute Pancreatitis for severity and for predicting the prognosis in early hours. Keywords: Acute pancreatitis, BISAP score pancreatic necrosis organ f

Introduction: The purpose of the study was to compare different parameters used in Ranson’s Criteria, Bedside Index of Severity in Acute Pancreatitis (BISAP), Acute Physiology and Chronic Health Evaluation (APACHE-II), and modified computed tomography severity index (MCTSI) for predicting the severity of acute pancreatitis and formulate a new scoring system to assess the severity of acute pancreatitis based on their prognostic severity index in the local population.&#x0D; Materials and Methods: This prospective pilot study was conducted at Rawalpindi Medical University allied hospitals from August 2019 to December 2019. All patients with a diagnosis of acute pancreatitis were included in the study through non-probability convenient sampling. Different scoring parameters were entered into standardized proforma.&#x0D; Results: 100 patients were included in the pilot study with a mean age of 46.53 ± 15.324. Among 24 parameters from APACHE-II, Ranson’s, BISAP, and MCTSI, only 11 parameters, Pleural effusion (PE), Pancreatic necrosis (PN), LDH, serum Calcium (Sca++), Pulse, GCS, MCTS1, Base deficit, Po2, BUN-24, and BUN-48 were significantly related(at 10% level of significance) with the severity of acute pancreatitis. Similarly out of 24, 10 parameters AST, LDH, Sca++, Pulse, PE, PN, Base deficit, MCTS1, Po2, and BUN 48were significantly covered more than 50% of the area in AUC analysis. Our proposed criteria based on 9 parameters LDH, Sca++, Pulse, PE, PN, Base deficit, MCTS1, Po2, and BUN 48which were blowing by the two methods (ANOVA and ROC). The sensitivity and specificity were higher with our proposed criteria 93.1% and 60.6%respectively as compared to the Ranson’s, modified Ranson, BISAP, and APACHE-II criteria.&#x0D; Conclusion: The newly proposed criteria for the assessment of the severity of AP is superior as compared to old criteria.

Background Acute pancreatitis (AP) isan acute inflammatory condition of the pancreas, peri-pancreatic tissues, and several organs, leading to multiple organ dysfunction syndrome and a higher risk of mortality. For many years, scoring systems that include biochemical, radiological, and clinical criteria for determining severity have been used. Though numerous studies have used various scoring methods to evaluate the severity of AP, this study has been conducted to compare four scoring systems: bedside index of severity in AP (BISAP), acute physiology and chronic health evaluation (APACHE II), Ranson's, and modified CT severity index (CTSI)based on clinical, biochemical, and radiological parameters. Materials and methods It was a prospective-comparative study. The study was conducted from December 2016 to August 2018 in the Department of General Surgery at Byramjee Jeejeebhoy Government Medical College (B.J.G.M.C.)and Sassoon Hospital, Pune, Maharashtra, India. A total of 75 participants were enrolled in the study. Results The study population ranged from 18 to 68 years, with a mean age of 40.8±11.5 years. AP was most prevalent in the age group of 31-40 years (33.3% cases). Out of 75 patients in this study, 14 patients (18.7%) had severe AP (SAP), 18 patients (24%) had moderate SAP, and 43 patients (57.3%) had mild AP. Ten patients expired, with a mortality rate of 13.3%. It has been observed that the BISAP score had the best specificity (100%) and the CTSI score had the highest sensitivity (96.9%) among our study's four scores for predicting pancreatic necrosis. When predicting persistent organ failure, BISAP had the highest specificity, and Ranson and CTSI scored the highest sensitivity. The modified CTSI poorly predicted AP, patients' mortality, and SAP. Conclusion The BISAP score provides a straightforward and accurate way to analyze the seriousness of AP. Ranson's score is also a reliable indicator of ongoing organ failure among AP cases. The most reliable technique for predicting pancreatitis mortality is the APACHE II score.

Objective To evaluate the six scoring systems and four laboratory tests, including pancreatitis outcome prediction (POP), Ranson score, bedside index for severity in acute pancreatitis (BISAP), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), systemic inflammatory response syndrome (SIRS), and Glasgow score as well as four laboratory tests including C-reactive protein (CRP), hematocrit (HCT), blood urea nitrogen (BUN) and serum creatinine (Scr) in the prognostic assessment of severe acute pancreatitis (SAP). Methods From January 2016 to December 2017, at Sir Run Run Shaw Hospital, 151 SAP patients who met the enrollment criteria were retrospectively analyzed. According to the time from onset to treatment, the patients were divided into less than three days group (n=102) and over three days group (n=49). The evaluation of six scoring systems and four laboratory tests, including CRP, HCT, BUN and Scr at 0, 24 and 48 h after hospitalization in the prognostic assessment of SAP patients was measured by receiver-operating characteristic (ROC) curve. Results The Ranson score had the highest area under curve (AUC) value (0.916) in the evaluation of the prognosis of SAP patients less than three days group followed by BISAP, APACHEⅡ, Glasgow and POP score, and their AUC values were 0.832, 0.823, 0.793, and 0.787, respectively, all of them were statistically significant in the prognostic assessment of SAP patients in less than three days group (all P<0.05). There were statistically significant of BISAP and APACHEⅡ scores in the prognostic evaluation of SAP patients in over three days group (both P<0.05), and the AUC values were 0.751 and 0.735, respectively, which were less than those of SAP patients in less than three days group. There were statistical significance of BUN and Scr at 24 and 48 h after hospitalization in the prognostic assessment of SAP patients in less than three days group (all P<0.05), and the AUC values were 0.856, 0.853 and 0.793, 0.874, respectively. There were statistical significance of BUN at 0, 24, 48 h and Scr at 48 h after hospitalization in the prognostic assessment of SAP patients in over three days group (all P<0.05), and the AUC value was 0.709, 0.754, 0.742 and 0.716, respectively. Conclusions Ranson, POP and Glascow score systems are only suitable for patients with SAP less than three days. APACHEⅡ, BISAP score systems, BUN and Scr can be used to evaluate patients with SAP over three days, but are more suitable for patients with SAP less than three days group. Key words: Severe acute pancreatitis; pancreatitis of outcome prediction; Ranson score; BISAP; APACHE Ⅱ; systemic inflammatory response syndrome; Glasgow; ROC curve

BackgroundEarly diagnosis and accurate assessment of the severity of the disease are critical factors in the management of acute pancreatitis (AP). In this study, we investigated the success rates of combinations of Bedside Index of Severity in Acute Pancreatitis (BISAP) scores with C-reactive protein (CRP) values in predicting severe AP.MethodsThe medical records of all patients with AP admitted to our hospitals from September 2015 to September 2018 were reviewed retrospectively. To evaluate the severity of AP, the revised Atlanta criteria were used, and patients who developed organ failure lasting more than 48 hours were considered to have severe AP. We analyzed patient CRP values at the 24-hour mark via receiver operating characteristic (ROC) curve analysis. Four groups were then formed to separate mild AP from moderate to severe AP. The first group had BISAP scores ≥ 3, the second group had CRP values ≥ 90.7 mg/L, the third group had BISAP scores ≥ 3 and CRP values ≥ 90.7 mg/L, and the fourth group had BISAP scores ≥ 3 or measured CRP values ≥ 90.7 mg/L. Predictive accuracy, sensitivity, specificity, and positive and negative predictive values of groups in the prediction of severe AP were calculated.ResultsOur study population consisted of 207 patients, and according to the revised Atlanta scoring, 165 patients (79.7%) had mild AP, 30 (14.4%) had moderate, and 12 (5.8%) had severe AP. Comparing the mild, moderate, severe AP groups, we noted a significant difference between the mean hospital stay time, BISAP scores, and CRP values (p<0.001). Group 1, 2, 3, and 4 values of mild AP and all severe AP (moderate and severe) were significant (p<0.001). The highest specificity values were found in Group 3 (97.6%), while the highest sensitivity values were observed in Group 4 (88.1%).Conclusion CRP may increase the success of BISAP scoring in predicting the severity of AP.

To establish a machine learning model based on extreme gradient boosting (XGBoost) algorithm for early prediction of severe acute pancreatitis (SAP), and explore its predictive efficiency. A retrospective cohort study was conducted. The patients with acute pancreatitis (AP) who admitted to the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University from January 1, 2020 to December 31, 2021 were enrolled. Demography information, etiology, past history, and clinical indicators and imaging data within 48 hours of admission were collected according to the medical record system and image system, and the modified CT severity index (MCTSI), Ranson score, bedside index for severity in acute pancreatitis (BISAP) and acute pancreatitis risk score (SABP) were calculated. The data sets of the First Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University were randomly divided into training set and validation set according to 8 : 2. Based on XGBoost algorithm, the SAP prediction model was constructed on the basis of hyperparameter adjustment by 5-fold cross validation and loss function. The data set of the Second Affiliated Hospital of Soochow University was served as independent test set. The predictive efficacy of the XGBoost model was evaluated by drawing the receiver operator characteristic curve (ROC curve), and compared it with the traditional AP related severity score; variable importance ranking diagram and Shapley additive explanation (SHAP) diagram were drawn to visually explain the model. A total of 1 183 AP patients were enrolled finally, of which 129 (10.9%) developed SAP. Among the patients from the First Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University, there were 786 patients in the training set and 197 in the validation set; 200 patients from the Second Affiliated Hospital of Soochow University were used as the test set. Analysis of all three datasets showed that patients who advanced to SAP exhibited pathological manifestation such as abnormal respiratory function, coagulation function, liver and kidney function, and lipid metabolism. Based on the XGBoost algorithm, an SAP prediction model was constructed, and ROC curve analysis showed that the accuracy for prediction of SAP reached 0.830, the area under the ROC curve (AUC) was 0.927, which was significantly improved compared with the traditional scoring systems including MCTSI, Ranson, BISAP and SABP, the accuracy was 0.610, 0.690, 0.763, 0.625, and the AUC was 0.689, 0.631, 0.875, and 0.770, respectively. The feature importance analysis based on the XGBoost model showed that the top ten items ranked by the importance of model features were admission pleural effusion (0.119), albumin (Alb, 0.049), triglycerides (TG, 0.036), Ca2+ (0.034), prothrombin time (PT, 0.031), systemic inflammatory response syndrome (SIRS, 0.031), C-reactive protein (CRP, 0.031), platelet count (PLT, 0.030), lactate dehydrogenase (LDH, 0.029), and alkaline phosphatase (ALP, 0.028). The above indicators were of great significance for the XGBoost model to predict SAP. The SHAP contribution analysis based on the XGBoost model showed that the risk of SAP increased significantly when patients had pleural effusion and decreased Alb. A SAP prediction scoring system was established based on the machine automatic learning XGBoost algorithm, which can predict the SAP risk of patients within 48 hours of admission with good accuracy.

Prognostic indicators in acute pancreatitis: CT vs APACHE II

AimTo investigate the predictive value of C-reactive protein (CRP) to serum albumin (ALB) ratio in the severity and prognosis of acute pancreatitis (AP), and compare the predictive value of the CRP/ALB ratio with the Ranson score, modified computed tomography severity index (MCTSI) score, and Bedside Index of Severity in Acute Pancreatitis (BISAP) score.MethodsThis cohort study retrospectively analyzed clinical data of AP patients from August 2018 to August 2020 in our hospital. Logistic regression analysis was utilized to determine the effects of CRP/ALB ratio, Ranson, MCTSI, and BISAP score on severe AP (SAP), pancreatic necrosis, organ failure, and death. The predictive values of CRP/ALB ratio, Ranson, MCTSI, and BISAP score were examined with the area under the curve (AUC) of the receiver operator characteristic (ROC) curve analysis. DeLong test was used to compare the AUCs between CRP/ALB ratio, Ranson, MCTSI, and BISAP score.ResultsTotally, 284 patients were included in this study, of which 35 AP patients (12.32%) developed SAP, 29 (10.21%) organ failure, 30 (10.56%) pancreatic necrosis and 11 (3.87%) died. The result revealed that CRP/ALB ratio on day 2 was associated with SAP [odds ratio (OR): 1.74, 95% confidence interval (CI): 1.32 to 2.29], death (OR: 1.73, 95%CI: 1.24 to 2.41), pancreatic necrosis (OR: 1.28, 95%CI: 1.08 to 1.50), and organ failure (OR: 1.43, 95%CI: 1.18 to 1.73) in AP patients. Similarly, CRP/ALB on day 3 was related to a higher risk of SAP (OR: 1.50, 95%CI: 1.24 to 1.81), death (OR: 1.8, 95%CI: 1.34 to 2.65), pancreatic necrosis (OR: 1.22, 95%CI: 1.04 to 1.42), and organ failure (OR: 1.21, 95%CI: 1.04 to 1.41). The predictive value of CRP/ALB ratio for pancreatic necrosis was lower than that of MCTSI, for organ failure was lower than that of Ranson and BISAP, and for death was higher than that of MCTSI.ConclusionThe CRP/ALB ratio may be a novel but promising, easily measurable, reproducible, non-invasive prognostic score that can be used to predict SAP, death, pancreatic necrosis, and organ failure in AP patients, which can be a supplement of Ranson, MCTSI, and BISAP scores.

Comparing prognostic scoring systems in acute pancreatitis: Bedside Index of Severity in Acute Pancreatitis, WL, and Chinese Simple Scoring System Scores.

Building and verifying a severity prediction model of acute pancreatitis (AP) based on BISAP, MEWS and routine test indexes