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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 10
Oct.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(10): 2432-2442

Establishment of a modified BISAP scoring system and its clinical significance in the early diagnosis and prognostic evaluation of severe acute pancreatitis

DOI: 10.3969/j.issn.1001-5256.2023.10.022

  • Department of Gastroenterology，Third Xiangya Hospital，Central South University，Changsha 410013，China

Research funding:

Natural Science Foundation of Hunan Province (2020JJ8107)

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  • Corresponding author: LIU Shaojun， cslsj169@126.com （ORCID： 0000－0002－8386－8109）
  • Received Date: 2023-02-06
  • Published Date: 2023-10-30
    Abstract
  •   Objective  To establish a modified BISAP scoring system， and to investigate the value of the BISAP scoring system versus the modified BISAP scoring system in assessing the severity and condition of acute pancreatitis （AP）.  Methods  For the establishment of the new scoring system， a retrospective analysis was performed for the clinical data of 1 033 patients with AP who were admitted to Third Xiangya hospital of central South University from January 2019 to December 2021， and according to the revised Atlanta classification， they were divided into mild acute pancreatitis （MAP） group with 827 patients and severe acute pancreatitis （SAP） group with 206 patients. The two groups were compared in terms of clinical features， laboratory markers， and imaging data. A binary logistic regression analysis was performed for the statistically significant indicators to screen for the independent risk factors for SAP. The receiver operating characteristic （ROC） curve was used to obtain the optimal cut－off value corresponding to the maximum Youden index for each independent risk factor， and a score of 0 or 1 was assigned depending on different situations， which was integrated into the BISAP scoring system to establish a modified BISAP scoring system. For the validation of the new scoring system， a retrospective analysis was performed for the clinical data of 473 patients with AP who were admitted to Third Xiangya hospital of central South University from January 2017 to December 2018. BISAP score and modified BISAP score were determined for each patient， and the area under the ROC curve （AUC） was used to compare the value of the two scoring systems in predicting the severity and prognosis of AP. The chi－square test or the Fisher’s exact test was used for comparison of categorical data between two groups， and the independent－samples t test and the Mann－Whitney U test were used for comparison of continuous data between two groups.  Results  For the establishment of the new scoring system， there were significant differences between the MAP group and the SAP group in mode of admission， length of hospital stay， ICU admission rate， number of deaths， underlying diseases， and incidence rate of complications （all P<0.05）. The binary logistic regression analysis showed that body temperature， neutrophil－to－lymphocyte ratio （NLR）， C－reactive protein （CRP）， albumin， triglycerides， D－dimer， fibrinogen， and MCTSI score were independent risk factors for SAP （all P<0.05）. The ROC curve analysis showed that CRP （AUC=0.921）， NLR （AUC=0.798）， D－dimer （AUC=0.768）， and MCTSI score （AUC=0.931） had a good predictive value for SAP， and the combination of these four indicators had an AUC of 0.976 and showed a significantly higher diagnostic efficiency than each indicator alone or the combination of two or three indicators （all P<0.05）. For the validation of the new scoring system， a total of 473 patients were enrolled， with 408 in the MAP group and 65 in the SAP group， and there were significant differences between the two groups in mode of admission， length of hospital stay， ICU admission rate， number of deaths， and incidence rate of complications （all P<0.05）. The modified BISAP score was better than the BISAP score in predicting SAP （AUC： 0.972 vs 0.887， P<0.05）， with an optimal cut－off value of >3 points. The modified BISAP score also had a relatively high value in predicting the mortality of AP patients （AUC=0.910）， but there was no significant difference between the modified BISAP score and the BISAP scoring system （AUC： 0.910 vs 0.896， P=0.707）.  Conclusion  The modified BISAP score is better than the BISAP score in predicting the severity of AP and has a relatively high value in predicting the mortality of AP patients， giving a more accurate， objective， and early assessment of the condition of AP patients.

     

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    • References(32)
  • [1]
    LANKISCH PG, APTE M, BANKS PA. Acute pancreatitis[J]. Lancet, 2015, 386( 9988): 85－ 96. DOI: 10.1016/S0140－6736(14)60649－8.
    [2]
    Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association. Guidelines for diagnosis and treatment of acute pancreatitis in China(2021)[J]. Chin J Dig Surg, 2021, 20( 7): 730－ 739. DOI: 10.3760/cma.j.cn115610－20210622－00297.

    中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南(2021)[J]. 中华消化外科杂志, 2021, 20( 7): 730－ 739. DOI: 10.3760/cma.j.cn115610－20210622－00297.
    [3]
    LUO XP, WANG J, WU Q, et al. Reasearch advances in acute pancreatitis scoring system[J]. J Clin Hepatol, 2022, 38( 9): 2188－ 2192. DOI: 10.3969/j.issn.1001－5256.2022.09. 046.

    罗秀平, 王洁, 吴青, 等. 急性胰腺炎评分系统的研究进展[J]. 临床肝胆病杂志, 2022, 38( 9): 2188－ 2192. DOI: 10.3969/j.issn.1001－5256.2022.09.046.
    [4]
    LI YF, XU F, XIAO JC, et al. The value of lactate dehydrogenase combined with BISAP scoring in predicting acutepancreatitis complicated with persistent organ damage[J]. Mod Med J, 2015, 43( 4): 459－ 462. DOI: 10.3969/j.issn. 1671－7562. 2015.04.016.

    李玉芳, 徐峰, 肖接承, 等. 乳酸脱氢酶联合BISAP评分预测急性胰腺炎并发持续器官损害的价值[J]. 现代医学, 2015, 43( 4): 459－ 462. DOI: 10.3969/j.issn.1671－7562.2015.04. 016.
    [5]
    BANKS PA, BOLLEN TL, DERVENIS C, et al. Classification of acute pancreatitis－2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62( 1): 102－ 111. DOI: 10.1136/gutjnl－2012－302779.
    [6]
    WU BU, JOHANNES RS, SUN X, et al. The early prediction of mortality in acute pancreatitis: a large population－based study[J]. Gut, 2008, 57( 12): 1698－ 1703. DOI: 10.1136/gut.2008.152702.
    [7]
    TRIKUDANATHAN G, WOLBRINK D, van SANTVOORT HC, et al. Current concepts in severe acute and necrotizing pancreatitis: an evidence－based approach[J]. Gastroenterology, 2019, 156( 7): 1994－ 2007. e 3. DOI: 10.1053/j.gastro.2019.01.269.
    [8]
    VALVERDE－LÓPEZ F, MATAS－COBOS AM, ALEGRÍA－MOTTE C, et al. BISAP, RANSON, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort[J]. J Gastroenterol Hepatol, 2017, 32( 9): 1649－ 1656. DOI: 10.1111/jgh.13763.
    [9]
    HAGJER S, KUMAR N. Evaluation of the BISAP scoring system in prognostication of acute pancreatitis－A prospective observational study[J]. Int J Surg, 2018, 54(PtA): 76－ 81. DOI: 10. 1016/j.ijsu.2018.04.026.
    [10]
    HARSHIT KUMAR A, SINGH GRIWAN M. A comparison of APACHE II,BISAP,Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification[J]. Gastroenterol Rep, 2018, 6( 2): 127－ 131. DOI: 10.1093/gastro/ gox029.
    [11]
    MIKO A, VIGH É, MÁTRAI P, et al. Computed tomography severity index vs.other indices in the prediction of severity and mortality in acute pancreatitis:a predictive accuracy meta analysis[J]. Front Physiol, 2019, 10: 1002. DOI: 10.3389/fphys.2019.01002.
    [12]
    NING XX, PENG J. The value of modified CT severity index combined with BISAP score for acute pancreatitis[J]. J Clin Radiol, 2022, 41( 4): 659－ 663. DOI: 10.13437/j.cnki. jcr.2022.04.035.

    宁晓详, 彭婕. 改良CT严重程度指数联合BISAP评分对早期急性胰腺炎预测价值[J]. 临床放射学杂志, 2022, 41( 4): 659－ 663. DOI: 10.13437/j.cnki.jcr.2022.04.035.
    [13]
    LEE KJ, KIM HM, CHOI JS, et al. Comparison of predictive systems in severe acute pancreatitis according to the revised atlanta classification[J]. Pancreas, 2016, 45( 1): 46－ 50. DOI: 10.1097/MPA.0000000000000433.
    [14]
    STIRLING AD, MORAN NR, KELLY ME, et al. The predictive value of C－reactive protein(CRP) in acute pancreatitisis interval change in CRP an additional indicator of severity?[J]. HPB(Oxford), 2017, 19( 10): 874－ 880. DOI: 10.1016/j.hpb.2017.06.001.
    [15]
    KE L, TONG ZH, LI WQ, et al. Predictors of critical acute pancreatitis: a prospective cohort study[J]. Medicine(Baltimore), 2014, 93( 21): e108. DOI: 10.1097/MD.0000000000000108.
    [16]
    STERNBY H, HARTMAN H, JOHANSEN D, et al. IL－6 and CRP are superior in early differentiation between mild and nonmild acute pancreatitis[J]. Pancreatology, 2017, 17( 4): 550－ 554. DOI: 10.1016/j.pan.2017.05.392.
    [17]
    STAUBLI SM, OERTLI D, NEBIKER CA. Laboratory markers predicting severity of acute pancreatitis[J]. Crit Rev Clin Lab Sci, 2015, 52( 6): 273－ 283. DOI: 10.3109/10408363.2015.1051659.
    [18]
    LEPPÄNIEMI A, TOLONEN M, TARASCONI A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis[J]. World J Emerg Surg, 2019, 14: 27. DOI: 10.1186/s13017－019－0247－0.
    [19]
    van den BERG FF, de BRUIJN AC, van SANTVOORT HC, et al. Early laboratory biomarkers for severity in acute pancreatitis;A systematic review and meta－analysis[J]. Pancreatology, 2020, 20( 7): 1302－ 1311. DOI: 10.1016/j.pan.2020.09.007.
    [20]
    MATOWICKA－KARNA J. Markers of inflammation, activation of blood platelets and coagulation disorders in inflammatory bowel diseases[J]. Postepy Hig Med Dosw(Online), 2016, 70: 305－ 312. DOI: 10.5604/17322693.1199305.
    [21]
    LELUBRE C, ANSELIN S, ZOUAOUI BOUDJELTIA K, et al. Interpretation of C－reactive protein concentrations in critically ill patients[J]. Biomed Res Int, 2013, 2013: 124021. DOI: 10.1155/2013/124021.
    [22]
    KONG W, HE Y, BAO H, et al. Diagnostic value of neutrophil－lymphocyte ratio for predicting the severity of acute pancreatitis: a meta－analysis[J]. Dis Markers, 2020, 2020: 9731854. DOI: 10.1155/2020/9731854.
    [23]
    UEDA T, TAKEYAMA Y, YASUDA T, et al. Immunosuppression in patients with severe acute pancreatitis[J]. J Gastroenterol, 2006, 41( 8): 779－ 784. DOI: 10.1007/s00535－006－1852－8.
    [24]
    HUANG L, CHEN C, YANG L, et al. Neutrophil－to－lymphocyte ratio can specifically predict the severity of hypertriglyceridemia－induced acute pancreatitis compared with white blood cell[J]. J Clin Lab Anal, 2019, 33( 4): e22839. DOI: 10.1002/jcla.22839.
    [25]
    ZHOU TY, PAN T, LIU JL, et al. Value of the neutrophil－lymphocyte ratio for predicting the severity of acute pancreatitis based on the Revised Atlanta Classification[J]. J Shanghai Jiaotong Univ(Med Sci), 2016, 36( 7): 1023－ 1028. DOI: 10.3969/j.issn.1674－8115.2016.07.013.

    周天昀, 潘婷, 刘嘉琳, 等. 中性粒细胞与淋巴细胞比值在亚特兰大新分类标准下预测急性胰腺炎严重程度的价值[J]. 上海交通大学学报(医学版), 2016, 36( 7): 1023－ 1028. DOI: 10.3969/j.issn.1674－8115.2016.07.013.
    [26]
    GEZER NS, BENGI G, BARAN A, et al. Comparison of radiological scoring systems, clinical scores, neutrophil－lymphocyte ratio and serum C－reactive protein level for severity and mortality in acute pancreatitis[J]. Rev Assoc Med Bras(1992), 2020, 66( 6): 762－ 770. DOI: 10.1590/1806－9282.66.6.762.
    [27]
    WANG Y, LI MZ, LIU YF, et al. Early predictors for acute kidney injury in acute pancreatitis[J]. J Clin Hepatol, 2022, 38( 5): 1192－ 1197. DOI: 10.3969/j.issn.1001－5256.2022. 05.046.

    王岩, 李明政, 刘玉凤, 等. 急性胰腺炎发生急性肾损伤的早期预测指标[J]. 临床肝胆病杂志, 2022, 38( 5): 1192－ 1197. DOI: 10.3969/j.issn.1001－5256.2022. 05.046.
    [28]
    LI Y, ZHAO YJ, YU HY, et al. Predictive value of soluble urokinase－type plasminogen activator receptor in patients with severe acute pancreatitis[J]. J Army Med Univ, 2022, 44( 3): 241－ 245. DOI: 10.16016/j.2097－0927.202107019.

    李杨, 赵胤杰, 余海燕, 等. 血浆可溶性尿激酶型纤溶酶原激活物受体对重症急性胰腺炎的预测价值[J]. 陆军军医大学学报, 2022, 44( 3): 241－ 245. DOI: 10.16016/j. 2097－0927. 202107019.
    [29]
    LI Q, LIU CN, LING LQ, et al. Association between coagulation function and prognosis in patients with acute pancreatitis[J]. J South Med Univ, 2022, 42( 7): 1006－ 1012. DOI: 10.12122/j.issn.1673－4254.2022.07.06.

    李勤, 刘超男, 凌莉琴, 等. 凝血相关的实验室指标对急性胰腺炎患者的病情和预后有较高预测价值[J]. 南方医科大学学报, 2022, 42( 7): 1006－ 1012. DOI: 10.12122/j.issn. 1673－4254.2022.07.06.
    [30]
    ZHANG GQ, WANG G, LI L, et al. Plasma D－Dimer level is an early predictorof severity of acute pancreatitis based on 2012 atlanta classification[J]. Med Sci Monit, 2019, 25: 9019－ 9027. DOI: 10.12659/MSM.918311.
    [31]
    WAN J, YANG X, HE W, et al. Serum D－dimer levels at admission for prediction of outcomes in acute pancreatitis[J]. BMC Gastroenterol, 2019, 19( 1): 67. DOI: 10.1186/s12876－019－0989－x.
    [32]
    JI L, LV JC, SONG ZF, et al. Risk factors of infected pancreatic necrosis secondary to severe acute pancreatitis[J]. Hepatobiliary Pancreat Dis Int, 2016, 15( 4): 428－ 433. DOI: 10.1016/s1499－3872(15)60043－1.
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