BISAP Pancreatitis Score

Bedside Index for Severity in Acute Pancreatitis score

This BISAP pancreatitis score assesses early risk of complications occurring in patients with acute pancreatitis and reveals the risk of hospital mortality.

There are 5 items in the score and the more of them are positive, the higher the risk of acute pancreatitis complications and predicted mortality risk:

■ Blood urea nitrogen (BUN) increase higher than 25 mg/dL (8.92 mmol/L);

■ Impaired mental status (disorientation, lethargy, coma);

■ More than 2 SIRS criteria met (Temperature >38°C, 100°C; HR>90; RR>20 or PaCO₂ 12k);

■ Age higher than 60;

■ Pleural effusion present.

The amount of waste product nitrogen in the blood (BUN) is an indicator of the function of the pancreas, liver and kidney. Acute pancreatitis has as prevalent symptom acute changes in mental status.

Systemic Inflammatory Response Syndrome is suggestive of a pro inflammatory condition that risks developing into multiple organ failure. Age is a risk factor for complications of AP.

Pleural effusion that interferes with breathing of varying degrees is associated to severe pancreatic damage.

BISAP score interpretation

Each of positive answers at the five questions in the score is awarded 1 point.

Therefore, the minimum score is 0 and the maximum is 5. The following table introduces the BISAP scores and their respective predictions of mortality risk.

About the original study

The scoring system was derived using the Classification and Regression Tree (CART) analysis as a mean to support early identification of patients suffering from acute pancreatitis and at risk of in-hospital mortality.

Data collected from 17,992 cases was analysed. Mortality ranged from less than 1% in the low risk group and more than 20% in the highest risk group.

Subsequently, there was a validation study involving 18,256 cases. The score was also validated by comparing its predictive accuracy with that of the Acute Physiology and Chronic Health Examination, APACHE II score. In the validation cohort, the BISAP AUC was 0.82 (95% CI 0.79 to 0.84).

Dr. B. U. Wu is a gastroenterologist at Brigham and Women's Hospital in Boston. His research interests are in the area of acute and chronic pancreatitis.

Assessing pancreatitis

Most acute pancreatitis are caused by alcohol (35%) or gallbladder stones (45%). Other causes may include hypercalcemia, hypertriglyceridemia, viral infection, endoscopic retrograde cholangiopancreatography, vascular ischemia, duct obstruction or trauma.

AP occurs in people of all ages, but has affects with predilection middle age and elderly persons.

There are several other models, beside BISAP score, that address the potential adverse outcomes of acute pancreatitis:

■ Ranson Criteria – factors in admission status and evolution within 48 hours;

■ Acute physiology and chronic health examination APACHE II – predictor of hospital mortality in ICU;

■ Balthazar score – which takes account of the Computed tomography severity index (CTSI).

Original reference

Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008; 57(12):1698-703.

Validation

Papachristou GI, Muddana V, Yadav D, O'Connell M, Sanders MK, Slivka A, Whitcomb DC. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010; 105(2):435-41.

Other reference

Gao W, Yang HX, Ma CE. The Value of BISAP Score for Predicting Mortality and Severity in Acute Pancreatitis: A Systematic Review and Meta-Analysis. PLoS One. 2015; 10(6): e0130412.