A Study On BISAP In Predicting Severity Of Acute Pancreatitis And Prognosis Of TCM Syndrome Patterns In AP

Objects By evaluating and comparing the value of three scoring systems, Bedside index of severity in acute pancreatitis(BISAP), Ranson and Balthazar CT severity index(CTSI), in predicting the severity and prognosis of acute pancreatitis(AP), demonstrated the feasibility and advantages of BISAP in prediction. Study the relevance of the TCM syndrome patterns and disease severity in AP cases by BISAP, in order to assess the condition of the AP patients, guide clinical diagnosis and treatment, and also, provide the basis for the evaluation system of perfect Chinese medicine symptoms.Methods One hundred and twenty-three patients with acute pancreatitis admitted into Jiangsu Province Hospital of Traditional Chinese Medicine from June2010to March2012were retrospectively studied with Ranson, CTSI and BISAP scoring systems. We analyzed the relevance of the three scoring systems and severity of AP, duration of fasting, abdominal pain, hospitalization and fatality rate by the combination of retrospective and prospective study. Receiver operator characteristic curve was used to compare the values of Ranson、BISAP and CTSI in predicting severity and prognosis of acute pancreatitis. All the patients with AP were devided into five syndrome types according to the theory of Chinese medicine. Predict their prognosis by the comparison of BISAP, Ranson and CTSI scoring systems.Results The scores of three scoring systems between mild acute pancreatitis and severe acute pancreatitis were different (p<0.001).The scores of BISAP scoring system was correlated significantly with duration of fasting, abdominal pain, hospitalization and fatality rate. The analysis of the area under receiver operator characteristic curve shows that BISAP had a higher ability in predicting severity and death compared to other two scoring systems (p<0.05), the area under receiver operator characteristic curve of BISAP in predicting severity and death were0.863and0.942respectively. To the contrast, BISAP is not good at predicting local complications. BISAP scoring system could predict the severity and prognosis of AP. The sensitivity and specificity of BISAP were better than other two scoring systems in predicting mortality if the cut-piont was no less than3. AP for the largest proportion of the pattern of Damper-heat in liver and gallbladder, to41.46perccnt, followed by Liver Qi stagnation, Excessive-heat in spleen and stomach. The BISAP scores of five syndrome patterns differ significantly between the MAP group and SAP group (p<0.05). All three scoring systems, BISAP,Ranson,CTSI, of Stagnation of stasis and heat,and Fu-organ Qi obstruction and blood-stasis, have high scores than the other three patterns, which means their prognosis is not optimistic. For the thee syndrome patterns which happens frequently, Excessive-heat in spleen and stomach has a high score of BISAP in SAP group.Conclusion BISAP score is an effective indicator of the clinical evaluation of patients with AP, more suitable to judge the severity of the disease and possibility of death than the other two scorings; However, it has no obvious advantage in predicting local complications. The BISAP scores differ significantly between the five TCM syndrome patterns. The patterns of Liver Qi stagnation, and Excessive-heat in spleen and stomach account for the largest proportion of MAP, so as the other three patterns do to SAP. In addition, the BISAP scores indicate that the prognosis of the patterns of Stagnation of stasis and heat, and Fu-organ Qi obstruction and blood-stasis is poor. The patients with SAP of excessive-heat in spleen and stomach need more attention in early stage of clinical therapy because of their relevant-high scores of BISAP.