A COMPARATIVE STUDY BETWEEN BISAP SCORE AND JAPANESE SCORE FOR PREDICTING THE SEVERITY IN ACUTE PANCREATITIS

Abstract

Background: One of the most common medical condition which requires emergency surgery is Acute pancreatitis which occurs due to two major causes involving biliary disease and alcohol related condition in nearly 50-70% of the subjects .The disease manifests in a wide range of severity, like the mild peri pancreatic edema to the potentially life-threatening infected necrotizing and hemorrhagic pancreatitis. BISAP’s clinical score are widely used in assessing acute pancreatitis severity. Radiological evaluation using the Balthazar radiological CT severity index is being increasingly used to identify infected necrosis as well as to determine the pancreatitis severity. The most recent criterion for severity of acute pancreatitis, the new Japanese score (JPN) for the assessment of acute pancreatitis was prepared is also good predictor. There are limited studies comparing BISAP score and JSS score in acute pancreatitis. Hence the present was conducted in our institute with the objective to compare BISAP score and JAPANESE score to assess the severity of acute pancreatitis. Methods: An Observational study was done on Patients diagnosed to have acute pancreatitis at R. L. Jalappa Hospital and Research Centre, Kolar from December 2018 to September 2020. 64 subjects based on Universal sampling technique were included in the study. All the subjects were subjected to BISAP and JSS scoring and were graded. Their outcome in terms of time for recovery and complication like hemodynamic instability, bacteremia, ARDS, reactive pleural effusion, gastrointestinal tract hemorrhage, renal failure, and disseminated intravascular coagulation, SIRS, MODS and mortality etc. were documented. xi Data was entered into Microsoft excel data sheet and was analyzed using SPSS 22 version software. Categorical data was represented in the form of Frequencies and proportions. Chi-square test was used as test of significance for qualitative data. Continuous data was represented as mean and standard deviation. Graphical representation of data: MS Excel and MS word were used to obtain various types of graphs such as bar diagram and Pie diagram. p value (Probability that the result is true) of <0.05 was considered as statistically significant after assuming all the rules of statistical tests. Statistical software: MS Excel, SPSS version 22 (IBM SPSS Statistics, Somers NY, USA) was used to analyze data. Results: In the present study the mean age of subjects was 38.58 ± 14.18 years. Majority of subjects belonged to age group 31 to 40 years (37.5%). 95.3% were males and 4.7% were females. Mean BISAP grade was 2.05 ± 0.722. Mean JSS grade was 4.02 ± 1.241. Mean duration of SICU stay was 2.70 ± 0.937 days. 90.6% were given Somatostatin Analogue. 26.6% had Clinical Deterioration. 4.7% had AKI, ARDS and other organ failure respectively and 1.5% had Necrotizing Pancreatitis. Mortality rate was 10.9%. BISAP score of >2 had highest sensitivity of 57.14%, specificity of 78.95%, PPV of 25% and NPV of 93.7% in predicting mortality among acute pancreatitis subjects. JSS score of >4 had highest sensitivity of 57.14%, specificity of 66.67%, PPV of 17.4% and NPV of 92.7% in predicting mortality among acute pancreatitis subjects. Conclusion: From the study it was concluded that BISAP score was better than JSS score in predicting Severity of Acute pancreatitis (Mortality and Clinical deterioration).