Back ground: Multiple risk stratification tools for acute pancreatitis have been developed, but their clinical usefulness is limited. In Ranson's criteria and modified Glasgow score there are multiple parameters, of which some of them are not available in majority of hospitals in India. In addition, both are assessed after 48hrs, thereby missing potentially valuable early therapeutic window. The APACHE II score requires collection of large number of parameters some of which may not be relevant to prognosis. For this purpose, a simple and accurate clinical scoring system that is, Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system was developed. This scoring system is used for stratifying patients according to their risk of mortality and is able to identify patients at increased risk of mortality prior to the onset of organ failure. More over the data for BISAP score is collected within the first 24hrs of hospitalization. The ability to stratify patients early in their course is a major step in improving future management strategies in acute pancreatitis.

Materials and Methods: 50 patients admitted from November 2017 to January 2019 with acute pancreatitis were included in the study. BISAP score was calculated in all such patients, based on the data obtained within 24hrs of hospitalization. Patients were assessed for organ failure according to Marshall scoring system and followed throughout hospitalization for assessment of complications. Statistical analyses were made using Fischer’s exact probability test. The difference was assumed statistically significant when p< 0.05.

Results: There was a statistically highly significant trend for increasing mortality (p< 0.05) and intermediate markers of severity (p<0.05) that is transient organ failure, persistent organ failure and pancreatic necrosis with BISAP score ≥3.

Conclusion: The BISAP score represents a simple way to identify patients at risk of increased mortality and the development of intermediate markers of severity within 24 hours of presentation.

1. Bradley EL 3^rda clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. arch. 1993; 128:586-590.
2. Fagenholz PJ, Castillo CF, Harris NS, et al. Increasing United States hospital admissions for acute pancreatitis, 1988-2003. AnnEpidermiol2007;17:491-7.
3. PA, Freeman ML, Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006; 101:2379-400.
4. Ranson JH, Rifkind KM, Roses DF, et al. objective early identification of severe acute pancreatitis. Am J Gastroenterol 1974; 61:443-51.
5. Yeung YP, Lam BY, Yip AW.APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis. Hepatobiliary pancreat Dis Int 2006; 5:294-9.
6. Larvin M, McMahon MJ APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet 1989; 2:201-5.
7. Wu BU, Johannes RS, Sun X et al.The early prediction of mortality in acute Pancreatitis: a large population-based study. Gut 2008; 57: 1698 - 703.
8. Vikesh K. Singh et al. A prospective evaluation of the bedside index for severity in acute pancreatitis score in assessing mortality and intermediate markers of severity in acute pancreatitis am J Gastroenterol 2009; 104:966-971.
9. Bradley EL. A clinical based classification system for acute pancreatitis. Areh Surg 1993; 128: 586-590.

Dr Balaji Chittipotula

Postgraduate, Department of General Surgery, GEMS, Srikakulam