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Predicting Mortality in Patients with Severe Acute Pancreatitis

A simple new scoring system proved both sensitive and specific for mortality.

In patients with severe acute pancreatitis, identifying risk for mortality within 24 hours of presentation is critical. However, a simple scoring system to predict mortality based on routine laboratory and diagnostic test results has been lacking.

To provide such a system, investigators developed and prospectively evaluated the performance of a bedside index for severity in acute pancreatitis (BISAP) in 397 consecutive cases of acute pancreatitis at a tertiary care hospital. BISAP is scored on a scale of 0 to 5, based on how many of the following characteristics the patient has within 24 hours of presentation: blood urea nitrogen level >25 mg/dL, impaired mental status, systemic inflammatory response syndrome, age >60, and pleural effusion on imaging studies.

Organ failure occurred within 72 hours of presentation in 18% of cases (transient in 74%), and the overall 1-week mortality rate was 3.5%. The higher the BISAP score was, the greater the mortality rate (P for trend, <0.0001). A score of 3 was determined to be the optimal cutoff for predicting mortality: Death occurred in 18% of cases with BISAP scores 3 versus 1% of cases with scores <3. In terms of mortality, a BISAP score 3 had a sensitivity of 71%, a specificity of 83%, a positive predictive value of 18%, and a negative predictive value (NPV) of 99%. In addition, a BISAP score 3 was significantly associated with increased risk for organ failure overall (odds ratio, 7.4), persistent organ failure (OR, 12.7), and pancreatic necrosis (OR, 3.8).

Comment: The main advantage of the BISAP scoring system over others is its simplicity: Scores can be calculated quickly using easily accessible data. Its NPV for mortality (99%) is impressive. This study was conducted in a tertiary care setting with experts in all aspects of patient care. If the results are confirmed in a community setting, BISAP will likely become the standard prognostic scoring system to identify patients at risk for mortality and organ failure.

— Stuart Sherman, MD

Published in Journal Watch Gastroenterology September 18, 2009

Citation(s):

Singh VK 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 Apr; 104:966.

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