Comparative Evaluation of Harmless Acute Pancreatitis Score (HAPS) and Bedside Index of Severity in Acute Pancreatitis (BISAP) Scoring System in the Stratification of Prognosis in Acute Pancreatitis

Abstract

Acute pancreatitis is a common disease in patients presenting to the emergency room in any hospital. The most common causes are alcohol ingestion and gallstone disease. Diagnosis is usually based on clinical findings and elevated serum amylase and lipase levels. Imaging is often not necessary but may be used to confirm the diagnosis or rule out any other pathology or to evaluate for any complications. The majority of patients will have a mild, self-limiting disease but others may develop a severe fulminant course with organ failure. These patients are at high risk of developing complications, morbidity or mortality. Treatment of acute pancreatitis includes supportive treatment with antibiotics, fluids, analgesics and early enteral feeding. Several scores have been developed to predict the course of pancreatitis and help make informed decisions, monitoring and timely intervention. The majority of them are complicated, require extensive and expensive interventions or require time. Harmless acute pancreatitis score (HAPS) is one such score that is easy to calculate and is done at the time of admission, bedside index of severity in acute pancreatitis (BISAP) is another one requiring more parameters. The parameters used to calculate it are easily available and can be done at a majority of healthcare facilities in developing countries. HAPS thus seems to be a good option in aiding doctors in assessing acute pancreatitis. It may be considered as a standard scoring for acute pancreatitis for early and effective management. We have tried to study and compare the superiority of HAPS over BISAP in predicting prognosis in acute pancreatitis.

Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence

“…HAPS may offer significant advantages in the triage of AP patients when compared to other scoring systems, underscoring its potential utility in optimizing patient classification and guiding treatment strategies. In a study including 60 patients with the first attack of AP, Gupta et al [ 145 ] reported that the sensitivity, specificity, PPV, NPV, and AUC of HAPS predicting SAP were 90.91%, 59.81%, 33.33%, 96.67%, and 0.75, respectively. The high NPV indicated that HAPS could very accurately identify within the first hour of admission patients who had a mild course of disease, did not require intensive management, and were not at risk of dying from the disease[ 145 ].…”

“…In a study including 60 patients with the first attack of AP, Gupta et al [ 145 ] reported that the sensitivity, specificity, PPV, NPV, and AUC of HAPS predicting SAP were 90.91%, 59.81%, 33.33%, 96.67%, and 0.75, respectively. The high NPV indicated that HAPS could very accurately identify within the first hour of admission patients who had a mild course of disease, did not require intensive management, and were not at risk of dying from the disease[ 145 ]. Based on this result, they argued that the patient typically tended to experience a milder course of illness if the evaluation of HAPS yielded a negative result[ 145 ].…”

“…The high NPV indicated that HAPS could very accurately identify within the first hour of admission patients who had a mild course of disease, did not require intensive management, and were not at risk of dying from the disease[ 145 ]. Based on this result, they argued that the patient typically tended to experience a milder course of illness if the evaluation of HAPS yielded a negative result[ 145 ]. Conversely, in instances where the score was positive, the patient’s clinical progression could unfold in any direction, demonstrating the uncertainty associated with such an outcome[ 145 ].…”

“…Based on this result, they argued that the patient typically tended to experience a milder course of illness if the evaluation of HAPS yielded a negative result[ 145 ]. Conversely, in instances where the score was positive, the patient’s clinical progression could unfold in any direction, demonstrating the uncertainty associated with such an outcome[ 145 ]. In this same study, the sensitivity, specificity, PPV, NPV, and AUC of BISAP in the prediction of SAP were 63.64%, 100%, 100%, 92.45%, and 0.82, respectively[ 145 ].…”

A comparison of scoring systems and biomarkers to predict the severity of acute pancreatitis in patients referring to the emergency clinic

“…[10] There is no specific treatment for AP, and the treatment is supportive. [11] The treatment approach is mainly based on fluid administration, enteral nutrition, and pain management. [12] Scoring systems and biochemical markers that predict disease severity are widely used in AP management.…”