A comparative evaluation of radiologic and clinical scoring system in the early prediction of severity in acute pancreatitis

Background: Acute pancreatitis refers to an acute inflammatory process of the pancreas, usually accompanied by abdominal pain and elevations of serum pancreatic enzymes. This syndrome is usually a discrete episode, which may cause varying degrees of injury to the pancreas, and adjacent and distant organs. Acute pancreatitis is a serious disease with high morbidity and mortality rates some 80% were mid attack which recovers rapidly with conservative management. The rest of 20 % were severe, with protracted course that needs intensive care and specialized management. Materials and methods: It was a prospective study. First 50 patients attending the surgical emergency ward with clinical features of Acute Pancreatitis were evaluated clinically and subjected to laboratory and radiological investigations as per the designed Performa. Data pertinent to the scoring systems were recorded within 24 hours of admission to the hospital. For each of 50 patients included in the study, BISAP and MCTSI scores were calculated by the manner described by Knaus, et al. and Cardinal Health Database system. Results: BISAP and MCTSI was correlated well for mortality with high positive value of 0.904 which was highly significant (0.01). The ROC analysis for Mortality showed BISAP score had AUC of 0.904, P value (0.001) which was more than MCTSI score which had AUC of 0.845, P value (0.007). So BISAP was highly accurate with P value (0.001) and confidence interval of 0.873. BISAP score was highly sensitive (100%), specificity (60%) at score more than 3.5. MCTSI score sensitivity was 85%, specificity was 77% at score more than 7. Conclusions: BISAP score was found to have more sensitivity, specificity and Diagnostic accuracy than MCTSI score in prediction of assessing the severity of acute pancreatitis. Hence, BISAP score found to predict more number of patients and likelihood of progressing to severe disease. Larven, et al. stated the same in their study 42. Hence, BISAP is considered as better available score for assessing the severity than MCTSI score.