What is the mortality scoring system for acute pancreatitis?

From the Guidelines

The BISAP score is the most recommended mortality scoring system for pancreatitis due to its simplicity, accuracy, and ability to predict severe disease and mortality prior to the onset of organ failure 1.

Mortality Scoring Systems for Pancreatitis

Mortality scoring systems for pancreatitis are essential for predicting patient outcomes and guiding management decisions. The most commonly used systems include Ranson's criteria, APACHE II (Acute Physiology and Chronic Health Evaluation), BISAP (Bedside Index for Severity in Acute Pancreatitis), and the modified Glasgow score.

Key Characteristics of Scoring Systems

• Ranson's criteria evaluates 11 parameters at admission and within 48 hours, with mortality increasing significantly when more criteria are met (≥3 criteria indicates severe disease) 1.
• APACHE II is more complex but can be calculated daily, with scores ≥8 suggesting severe pancreatitis 1.
• BISAP is simpler, assessing 5 parameters (BUN >25 mg/dL, impaired mental status, SIRS, age >60, and pleural effusion), with scores ≥2 associated with higher mortality and severe disease 1.
• The modified Glasgow score uses 8 factors measured within 48 hours of admission.

Recommendation

The BISAP score is preferred due to its ability to identify patients at increased risk of mortality prior to the onset of organ failure, with a statistically significant cutoff value of 2 for the diagnosis of severe acute pancreatitis, organ failure, and mortality 1.

Clinical Application

These scoring systems help clinicians identify high-risk patients who may benefit from ICU admission, more aggressive fluid resuscitation, and closer monitoring. Early identification of severe cases allows for timely intervention, potentially reducing complications and mortality.

• A study of 161 patients found that different scoring systems showed similar predictive accuracy for severity of AP, but that APACHE-II demonstrated the highest accuracy for the prediction of SAP 1.
• However, the BISAP score has been shown to have similar accuracy to the APACHE-II score for predicting death and is a very simplified scoring system that can be easily applied in the earliest phases 1.

From the Research

Mortality Pancreatitis Scoring

• The BISAP score is a simple and accurate means for risk stratification in patients with acute pancreatitis, with a predictive accuracy similar to other scoring systems such as Ranson's, APACHE-II, and CTSI 2.
• The BISAP score has been shown to be a useful tool in predicting severity, pancreatic necrosis, and mortality in acute pancreatitis, with an area under the receiver-operating curve (AUC) of 0.81 for predicting severe acute pancreatitis and 0.74 for predicting mortality 2.
• Other studies have also confirmed the usefulness of the BISAP score in predicting outcomes in acute pancreatitis, with AUCs ranging from 0.875 to 0.906 for predicting severe pancreatitis, organ failure, and death 3.
• Comparison of different scoring systems has shown that the BISAP score is as good as APACHE-II but better than Ranson criteria, CTSI, CRP, hematocrit, and BMI in predicting severity, organ failure, and death in acute pancreatitis 3.
• Other markers such as NLR, CRP, and BUN have also been evaluated as predictors of outcome in acute pancreatitis, with NLR48h and CRP48h being independently associated with severe acute pancreatitis and CRP48h being independently associated with mortality 4.

Scoring Systems

• BISAP score: includes blood urea nitrogen >25 mg/dl, impaired mental status, systemic inflammatory response syndrome (SIRS), age >60 years, and pleural effusions 2.
• Ranson's criteria: includes multiple factors such as age, white blood cell count, blood glucose, and serum lactate dehydrogenase 2.
• APACHE-II score: includes multiple factors such as temperature, mean arterial pressure, and arterial pH 2.
• CTSI: includes computed tomography imaging scores 2.

Predictive Accuracy

• BISAP score: AUC 0.81 for predicting severe acute pancreatitis and 0.74 for predicting mortality 2.
• Ranson's criteria: AUC 0.94 for predicting severe acute pancreatitis 2.
• APACHE-II score: AUC 0.78 for predicting severe acute pancreatitis 2.
• CTSI: AUC 0.84 for predicting severe acute pancreatitis 2.
• NLR48h and CRP48h: AUC 0.89 for predicting severe acute pancreatitis when both criteria are met 4.