The BISAP score, NLR, CRP, or BUN: Which marker best predicts the outcome of acute pancreatitis?

Abstract

Acute pancreatitis is a common disease, and the mortality rate can be high. Thus, a risk assessment should be performed early to optimize treatment. We compared simple prognostic markers with the bedside index for severity in acute pancreatitis (BISAP) scoring system to identify the best predictors of severity and mortality. This retrospective study stratified disease severity based on the revised Atlanta criteria. The accuracies of the markers for predicting severe AP (SAP) were assessed using receiver operating characteristic curves. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each marker. Multivariate logistic regression analyses were used to identify independent predictors of SAP and mortality. The area under the curve (AUC) for the BISAP score was classified as fair for predicting SAP. The neutrophil-to-lymphocyte ratio at 48 hours (NLR48 h) and the C-reactive protein level at 48 hours (CRP48 h) had the best AUCs and were independently associated with SAP. When both criteria were met, the AUC was 0.89, sensitivity was 68%, and specificity was 92%. CRP48 h and hematocrit at 48 hours were independently associated with mortality. NLR48 h and CRP48 h were independently associated with SAP but not superior to the BISAP score at admission. Assessing NLR48 h and CRP48H together was most suitable for predicting SAP. The CRP level was a good predictive marker for mortality.

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

“…Table 1 presents a summary of relevant studies. The 43 studies 24–65 included 14,116 AP patients, with mean/median age ranging widely (35–72 years) as the rate of male patients (34%–86%).…”

“…Thirty‐four studies (79%) took place in Institutions in Asia, 24–28,30–35,37,39,41–52,54–56,58–62,65 7 in Europe, 36,38,40,53,57,63,64 2 in the USA 9,29 . Twenty‐one studies were prospective, 9,25,29,32–36,38,41,44,45,47,51–54,57,59,61,65 21 retrospective 24,26–28,30,31,37,39,40,42,46,48–50,55,56,58,60,62–64 and 1 cross‐sectional 43 . Three of the studies included both training and validation sets, 9,37,39 and one two cohorts of different age groups 50 .…”

“…Thirty-four studies (79%) took place in Institutions in Asia, [24][25][26][27][28][30][31][32][33][34][35]37,39,[41][42][43][44][45][46][47][48][49][50][51][52][54][55][56][58][59][60][61][62]65 7 in Europe, 36,38,40,53,57,63,64 2 in the USA. 9,29 Twenty-one studies were prospective, 9,25,29,[32][33][34][35][36]38,…”

65 yaş üstü hastalarda puanlama sistemlerinin şiddetli akut pankreatiti ve mortaliteyi erken öngörme açısından değerlendirilmesi

“…In one study 42 , the AUC for mortality based on the BISAP score was 0.88, and the sensitivity was 92% and the specificity was 76% when the cut-off value of the BISAP score was 3. In a study by Dancu et al 43 , the AUC for SAP based on the BISAP score was 0.77, and the sensitivity was 61% and the specificity was 88% when the cut-off value of the BISAP score was ≥2. Kim et al 44 showed that BISAP is more accurate in predicting the severity of acute pancreatitis than CTSI scores in a Korean population.…”

Aberrant blood cell division cycle 42 expression and its correlation with disease severity, inflammation and mortality risk in patients with acute pancreatitis

“…Therefore, exploring biomarkers for predicting mortality risk is in urgent demand to improve the outcome of AP. Currently, the main methods of predicting mortality risk in AP include bedside index for severity in acute pancreatitis scoring system and neutrophil-to-lymphocyte ratio at 48 h, whose measurement parameters are relatively complicated ( 31 , 32 ). To identify an accurate and simple approach for predicting mortality risk, differences in CDC42 expression between patients who succumbed to AP, SAP and MSAP and those who survived were evaluated.…”