BISAP, RANSON, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort

Valverde-López, Francisco; Matas-Cobos, Ana M; Alegría-Motte, Carlos; Jiménez-Rosales, Rita; Úbeda-Muñoz, Margarita; Redondo–Cerezo, Eduardo

doi:10.1111/jgh.13763

Cited by 78 publications

(83 citation statements)

References 39 publications

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“…Second, as a laboratory test, a lactate measurement can be accomplished quickly with the advantages of low cost and high reproducibility. Third, as we mentioned above, in many studies, high lactate concentration portended a bad outcome in cases of critical illness, including septic shock, severe sepsis, organ failure, trauma, AP and other disease [17,18,22,27]. All of those observations suggest that initially elevated arterial lactate levels may be a simple marker to risk-stratify patients with SAP in the early stages of the disease.…”

Section: Discussionmentioning

confidence: 91%

“…2). For some of the secondary outcomes, we also observed mean differences, including abdominal compartment syndrome (3% vs 20%, P < 0.01), pancreatic necrosis (41% vs 63%, P < 0.01), walled-off necrosis (6% vs 21%, P < 0.01), hospital stay (13(9.5-19) vs 19 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], P = 0.01), need for ventilator support (26% vs 54%, P < 0.01) and hospital stay in the ICU (6 [3-11] vs 10 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], P < 0.01). However, for other secondary outcomes, such as portal vein thrombosis, pancreatic fistula, intestinal fistula and diabetes, there was no significant difference (Table 3).…”

Section: Comparison Of Primary and Secondary Outcomes According To DImentioning

confidence: 84%

“…In addition, previous studies have also found that the presence of elevated arterial lactate levels reflects critical tissue hypoperfusion, which is strongly associated with increased morbidity and mortality in critically ill patients [16][17][18][19][20][21]. A recent study has shown that elevated serum lactate is a new biomarker that could be an important tool in predicting poor outcomes of AP on admission, especially in predicting death [22]. Thus, we assume that arterial lactate may be a potentially promising biomarker to risk-stratify patients with SAP.…”

Section: Introductionmentioning

confidence: 99%

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Initially elevated arterial lactate as an independent predictor of poor outcomes in severe acute pancreatitis

et al. 2020

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Background: The present study aimed to investigate the relationships between arterial lactate levels and outcomes in severe acute pancreatitis. Methods: The study retrospectively analyzed the medical data of 329 patients with severe acute pancreatitis from January 2014 to February 2019. We compared baseline characteristics, laboratory data, severity scores, types of persistent organ failure, and primary and secondary outcomes of patients with and without elevated arterial lactate levels at admission. A multivariate logistic regression analysis model and receiver operating characteristic curve were adopted to evaluate the value of arterial lactate ≥4 mmol/L for identifying high-risk patients. Trends in arterial lactate levels were compared between patients in the survivor and nonsurvivor groups over a period of 7 days. Results: Compared to normal arterial lactate levels, patients with elevated arterial lactate levels show significantly higher incidences of multiple persistent organ failure (3% vs 30%, P < 0.01), death (2% vs 11%, P < 0.01), septic shock (4% vs 24%, P < 0.01), pancreatic infection (12% vs 37%, P < 0.01), abdominal compartment syndrome (3% vs 20%, P < 0.01), pancreatic necrosis (41% vs 63%, P < 0.01), and a need for ventilator support (26% vs 54%, P < 0.01). For predicting mortality, arterial lactate levels ≥4 mmol/L had a high hazard ratio (10, 95% CI; 3.7-27; P < 0.01) and the highest area under the curve (0.78). Conclusions:Our results indicate that initially elevated arterial lactate is independently associated with poor outcomes and death in patients with severe acute pancreatitis and may serve as an early high-risk stratification indicator.

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Section: Discussionmentioning

confidence: 91%

Section: Comparison Of Primary and Secondary Outcomes According To DImentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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Initially elevated arterial lactate as an independent predictor of poor outcomes in severe acute pancreatitis

et al. 2020

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“…Exponiendo el presente estudio se encontró que el sexo femenino es el más prevalente con un 57%; concordando con el estudio realizado en el departamento de gastroenterología del hospital de Gra-nada-España en el año 2017, el cual nos muestra una prevalencia del sexo femenino de 51.1% [13]. Probablemente la diferencia entre géneros se relacione más con la causa; ya que en los varones es más frecuente que la causa sea el consumo de alcohol, en las mujeres los cálculos biliares [12].…”

Section: Discussionunclassified

“…Es importante recalcar que afecciones crónicas previas, están relacionadas con la presencia y la persistencia de la insuficiencia orgánica. Se debe prestar atención especial a los pacientes que desarrollan insuficiencia orgánica y BISAP ≥ 3, ya que esto puede ser una señal importante de insuficiencia orgánica persistente [13] e ingreso a la unidad de cuidados intensivos [21].…”

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Escala BISAP en pancreatitis aguda. Azogues 2016-2017. Estudio descriptivo.

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Córdova

2019

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Objetivo: aplicar la escala Bedside Index for Severity in Acute Pancreatitis (BISAP) a los expedientes clínicos de pacientes con diagnóstico de pancreatitis aguda en el hospital Homero Castanier Crespo, Azogues enero de 2016 a diciembre de 2017. Metodología: se realizó un estudio cuantitativo, descriptivo y retrospectivo, se trabajó con el universo de expedientes clínicos con reporte de pancreatitis aguda de 2016 a 2017. Los datos se analizaron con los programas SPSS versión 20 y Excel, utilizando distribuciones de frecuencia y porcentajes. Resultados: se estudiaron 79 casos, encontrando una edad media de 48.5 años; el 57% correspondió al sexo femenino. Se obtuvo una mortalidad en general del 12.7%; siendo la forma leve el 79.7% de los casos sin fallecimientos; contrastando con la forma grave con el 20.3%, de los cuales el 62.5% fallecieron. Conclusiones: BISAP demostró ser un predictor de mortalidad, accesible, rápido y útil. Se aprecia una tendencia al incremento de la mortalidad conforme se eleva el puntaje de la escala, siendo esta directamente proporcional a la aparición de complicaciones locales y sistémicas propias de la enfermedad.

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Clinical usefulness of scoring systems to predict severe acute pancreatitis: A systematic review and meta‐analysis with pre and post‐test probability assessment

Capurso,

Ponz de Leon Pisani,

Lauri

et al. 2023

UEG Journal

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BackgroundScoring systems for severe acute pancreatitis (SAP) prediction should be used in conjunction with pre‐test probability to establish post‐test probability of SAP, but data of this kind are lacking.ObjectiveTo investigate the predictive value of commonly employed scoring systems and their usefulness in modifying the pre‐test probability of SAP.MethodsFollowing PRISMA statement and MOOSE checklists after PROSPERO registration, PubMed was searched from inception until September 2022. Retrospective, prospective, cross‐sectional studies or clinical trials on patients with acute pancreatitis defined as Revised Atlanta Criteria, reporting rate of SAP and using at least one score among Bedside Index for Severity in Acute Pancreatitis (BISAP), Acute Physiology and Chronic Health Examination (APACHE)‐II, RANSON, and Systemic Inflammatory Response Syndrome (SIRS) with their sensitivity and specificity were included. Random effects model meta‐analyses were performed. Pre‐test probability and likelihood ratio (LR) were combined to estimate post‐test probability on Fagan nomograms. Pooled severity rate was used as pre‐test probability of SAP and pooled sensitivity and specificity to calculate LR and generate post‐test probability. A priori hypotheses for heterogeneity were developed and sensitivity analyses planned.Results43 studies yielding 14,116 acute pancreatitis patients were included: 42 with BISAP, 30 with APACHE‐II, 27 with Ranson, 8 with SIRS. Pooled pre‐test probability of SAP ranged 16.6%–25.3%. The post‐test probability of SAP with positive/negative score was 47%/6% for BISAP, 43%/5% for APACHE‐II, 48%/5% for Ranson, 40%/12% for SIRS. In 18 studies comparing BISAP, APACHE‐II, and Ranson in 6740 patients with pooled pre‐test probability of SAP of 18.7%, post‐test probability when scores were positive was 48% for BISAP, 46% for APACHE‐II, 50% for Ranson. When scores were negative, post‐test probability dropped to 7% for BISAP, 6% for Ranson, 5% for APACHE‐II. Quality, design, and country of origin of the studies did not explain the observed high heterogeneity.ConclusionsThe most commonly used scoring systems to predict SAP perform poorly and do not aid in decision‐making.

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BISAP, RANSON, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort

Abstract: Bedside index for severity acute pancreatitis is a good predictive system for SAP, mortality, and ICU admission, being useful for triaging patients for ICU management. Lactate could be useful for developing new scores.

Cited by 78 publications

References 39 publications

Initially elevated arterial lactate as an independent predictor of poor outcomes in severe acute pancreatitis

Initially elevated arterial lactate as an independent predictor of poor outcomes in severe acute pancreatitis

Escala BISAP en pancreatitis aguda. Azogues 2016-2017. Estudio descriptivo.

Clinical usefulness of scoring systems to predict severe acute pancreatitis: A systematic review and meta‐analysis with pre and post‐test probability assessment

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