| Background：Acute pancreatitis (AP) was one of common acute abdominal diseases in digestivesystem. It is a process of acute inflammation of the pancreas and extra-pancreas, withvariable involvement of regional tissues or organ systems. It has been recognized for morethan a century, no definitive treatment has been developed. For most patients, pancreatitis isa mild and self-limiting illness. However, in around20-30%of cases, severelife-threatening complications may ensue with the development of associated organdysfunction caused by a systemic inflammatory response syndrome (SIRS). The mortalityrate of AP has been10%, although a lower mortality rate has been reported in recent studies.It was acknowledged that earlier treatment of severe acute pancreatitis （SAP） will resultin lower mortality. But it is not easy to judge the patients with SAP at the time of admission,because some of them may appear relatively well at the beginning. So, different traditionalscoring systems have been widely used to predict the severity of AP all over the world, suchas Ranson’s score, Acute Physiology and Chronic Health Evaluation (APACHE) II,Balthazar computed tomography severity index (CTSI), and Early Warning scores(EWS),and etc. While most scoring systems have their relative merits, researchers are still lookingfor an ideal predict system that allow rapid and accurate assessment of AP to suit differentregional hospitals. Recently, a new scoring system, named the bedside index for severity inacute pancreatitis (BISAP), has been published as an accurate and simple method for earlyprediction of severity and mortality.Papachristou has previously shown that the prognostic accuracy of BISAP is similar tothose of Ranson’s and other traditional scoring systems. This study examined BISAP from alarger group of patients in our hospital to determine if the prognostic value of BISAP stillheld true in China. Objective:The aim of this study was to evaluate the clinical values of the bedside index forseverity in acute pancreatitis (BISAP) and Ranson’s scoring systems in predicting severityand mortality in patients with acute pancreatitis (AP) in one hospital of China.Methods:All the data including case history, laboratory and radiographic from the patients withAP admitted into Xinqiao hospital of Third Military Medical University from June2007toOctober2011, were collected. The receiver-operating curve (ROC) of BISAP and Ranson’sscoring systems were compared in assessing severity and mortality in AP patients.Results:There were six hundred and fifty-two patients with AP. One hundred and forty threepatients were classified as severe acute pancreatitis (SAP). Median age was48years(interquartile range,38-59years; range,6-91years), and57.8%were men. The etiologies ofAP included biliary (52.3%), idiopathic (19.6%), hypertriglyceridemia (10.1%),alcohol(5.1%), post-endoscopic retrograde cholangiopancreatography (2.6%),pregnancypancreatitis(2.1%) and others (4.4%). Thirty patients died (mortality3.2%).Numbers of patients and their proportion with severe AP and mortality were stratifiedby the BISAP scoring system. The higher BISAP score, the fewer patients, and theproportion with SAP and mortality were significantly increased.When BISAP score equalsto4, the proportion of SAP and mortality were80%,60%, respectively (P＜0.05).The area under the receiver-operating curves (AUCs) for BISAP and Ranson’s inpredicting severity were0.846(95%CI0.808-0.883),0.771(95%CI0.722-0.820),respectively. The AUCs for BISAP and Ranson’s in predicting mortality were0.809(95%CI0.699-0.920)，0.762(95%CI0.638-0.885),respectively.Conclusions:BISAP score system is a more simple, accurate and dynamic method for the earlyprediction of severity and mortality in AP patients than Ranson’s. The role of BISAPscoring system in the initial staging of acute pancreatitis is very potent. BISAP is an easy,prompt, economical, and ideal prognosis scoring system in clinical practice, which shouldbe extended in China. |
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