DOI: http://dx.doi.org/10.18203/2349-2902.isj20184649

Clinical pattern of acute pancreatitis in eastern India and comparison of Ranson, BISAP and APACHE II as a predictor of severity, local complications and mortality

Nishith M. Paul Ekka, Gaurav Mishra, Vinod Kumar, Arun Kumar Tiwary, Tanushree Kar, Ashutosh Tiwary

Abstract


Background: Acute pancreatitis is the single most frequent gastrointestinal cause of hospital admissions. Scoring systems have been used since the 1970s for assessment of its severity. This study was aimed to assess the clinical pattern of acute pancreatitis and to compare various predicting systems like Ranson, BISAP and APACHE II in predicting severity, local complications and mortality in acute pancreatitis.

Methods: In this prospective study, 91 consecutive cases of acute pancreatitis admitted, between April 2015 to March 2017, were studied. The diagnostic criteria include the presence of at least two of the three features; abdominal pain, serum amylase and lipase levels and findings on imaging studies. Patients were divided into two groups each, BISAP Ranson ≥3 and <3, APACHE II ≥8 and <8, and analyzed statistically.

Results: Out of total of 91 patients, 81 were male and 14 were female with mean age was 36.14 years. Commonest aetiological factor was alcoholism in 57.89% followed by gallstones in 23.16%. Serum amylase was raised in 83.26% patients while 95.79% had raised serum lipase levels. 75.79% patients were of MAP while 24.21% patients were of MSAP and SAP. 7.37% patients developed local complications and mortality rate was 6.32%. All the scoring systems were found similar in predicting severity, local complication and mortality, had low sensitivity and high specificity (P value < 0.05).

Conclusions: There is no ideal predicting system for acute pancreatitis. These scoring systems can be used to triage patients for better healthcare delivery.


Keywords


APACHE II, Acute pancreatitis, BISAP, Predicting systems, Ranson

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References


Vege SS, Yadav D, Chari ST. Pancreatitis, In: Talley NJ, Locke GR, Saito YA, eds. GI Epidemiology. 1st edition. Blackwell Publishing, Malden, MA; 2007.

Sarr MG, Banks PA, Bollen TL, et al. Revision of the Atlanta classification of acute pancreatitis. Acute Pancreatitis Classification Workgroup, April 2008. Available at http://www.pancreasclub.com/resources/AtlantaClassification. Accessed April 8, 2011.

Banks PA, Bollen TL, Dervenis C. Classification of acute pancreatitis: revision of the Atlanta classification and definitions by International Consensus. Gut. 2013;62:102.

Ranson JHC, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139(1):69-81.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical Care Medicine. 1985;13(10):818-29.

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;57:1698-703

Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A, 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;105:435-41.

Baig SJ, Rahed A, Sen S. A prospective study of the aetiology, severity and outcome of acute pancreatitis in Eastern India. Trop Gastroenterol. 2008;29(1):20-2.

Vengadakrishnan K, Koushik AK. A study of the clinical profile of acute pancreatitis and its correlation with severity indices. Int J Health Sci (Qassim). 2015;9(4):410-7.

Nesvaderani M, Eslick GD, Vagg D, Faraj S, Cox MR. Epidemiology, aetiology and outcomes of acute pancreatitis: A retrospective cohort study. Int J Surg. 2015;23(A):68-74.

Efron G. The natural history of pancreatitis. Brit J Surg. 1966;53(8):702-6.

Chang MC, Su CH, Sun MS, Huang SC, Chiu CT, Chen MC, et al. Etiology of acute pancreatitis: a multi-center study in Taiwan. Hepatogastroenterol. 2003;50(53):1655-7.

Wang GJ, Gao CF, Wei D, Wang C, Ding SQ. Acute pancreatitis: etiology and common pathogenesis. WJG. 2009;15(12):1427-30.

Simoes M, Alves P, Esparto H, Canha C, Miera E, Ferreira E, et al. Predicting acute pancreatitis severity: comparison of prognostic scores. Gastroenterol Res. 2011;4:216-22.

Gomez D, Addison A, De Rosa A, Brooks A, Cameron IC. Retrospective study of patients with acute pancreatitis: is serum amylase still required? BMJ Open. 2012;2(5):e001471.

Chang JWY, Chung CH. Diagnosing acute pancreatitis: amylase or lipase? Hong kong J Emerg Med. 2011;18:20-4.

Yang L, Liu J, Xing Y, Du L, Chen J, Liu X, et al. Comparison of BISAP, Ranson, MCTSI, and APACHE II in Predicting Severity and Prognoses of Hyperlipidemic Acute Pancreatitis in Chinese Patients; Gastroenterol Res Pract. 2016;2016:1834256.

Khanna AK, Meher S, Prakash S, Tiwary SK, Singh U, Srivastava A, et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg. 2013;2013:367581.