Published: 2016-12-16

Validity of bedside index of severity in acute pancreatitis score in comparison with C reactive protein in assessing the severity of acute pancreatitis

Ramalingam Trivikraman, Ramesan Chayampurath, Joji I. Malieckal


Background: Acute pancreatitis is a process of acute inflammation of the pancreas usually caused by biliary stones, alcohol ingestion, metabolic factors or drugs. The assessment of the severity of acute pancreatitis has a significant role in its management. There is a need for a simple and clinically oriented severity scoring system that can predict severity of acute pancreatitis at the time of presentation.

Methods: A cross-sectional study was conducted at a tertiary care centre on 100 patients diagnosed as acute pancreatitis who fulfilled the inclusion criteria. Severity index, their BISAP Score, BMI and CRP values were calculated and statistical analysis was done using SPSS 17 Software.

Results: In our study, there were 100 patients with pancreatitis. 65% were alcoholic pancreatitis followed by gall stone pancreatitis (17%), idiopathic pancreatitis (13%), drug induced (1%), trauma (1%), post ERCP (1%) and malignancy (2%). On the basis of CT Severity index, it was found that 15% of alcoholic group, 8% of biliary group and 1% each of idiopathic, drug induced, trauma and malignancy group were found to have severe pancreatitis. On the basis of BISAP Score it was found that 17% in alcoholic group, 7% in gall stone group, 4% in idiopathic group, 2% in malignancy group and 1% each in drug induced and trauma group were having acute pancreatitis. With the C reactive Protein level, it was found that 16% in alcoholic group, 9% in biliary group and 1% each in idiopathic, trauma and malignancy group were found to have severe pancreatitis. The sensitivity and specificity for BISAP score were 77.8% and 84.9% and the sensitivity and specificity for CRP were 66.7% and 86.3%. The K-score was found to be 0.593 for BISAP Score and 0.524 for C - reactive protein levels. This indicates that both are in moderate agreement with the gold standard test (CT Severity Index).

Conclusions: BISAP score and CRP levels are not superior to the each other in predicting severity. BISAP score can be used as a predictor of severity at admission and CRP levels ≥150 can predict severity when serially monitored during the course of admission.


BISAP, CRP, CT severity index, Pancreatitis

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Townsend & Beauchamp & Evers & Mattox. Sabiston textbook of surgery: 20th edi. Chapter 55. 2016;1520-55.

Singh V, Wu BU, Maurer R. A prospective evaluation of the Bedside Index of Severity in Acute Pancreatitis. Am J Gastroenterology. 2009;104:966-71.

Balthazar EJ. Complications of acute pancreatitis: clinical and CT evaluation. Radiology Clin North Am. 2002;40(6):1211-27.

Lankisch PG, Assmus C, Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic diseases in Luneburg County. A study in a defined german population. Pancreatology. 2002; 2:469-77.

Clave P, Guillaumes S, Blanco I, Nabau N, Merce J, Farre A, et al. Amylase, lipase, pancreatic isoamylase, and phospholipase A in diagnosis of acute pancreatitis. Clin Chem. 1995;41:1129-3465.

Simchuk EJ, Traverso LW, Nukui Y, Kozarek RA. Computed tomography severity index is a predictor of outcomes for severe pancreatitis. Am J Surg. 2000;179(5):352-5.

Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, et al. Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis. AJR Am J Roentgenol. 2011;197(2):386-92.

Vriens PW, van de Linde P, Slotema ET, Warmerdam PE, Breslau PJ. Computed tomography severity index is an early prognostic tool for acute pancreatitis. J Am Coll Surg. 2005;201(4):497-502.

Surco Y, Mercado JH, Pinto J, Piscoya A, Ríos RL, Prochazka R, et al. Revista de Gastroenterología del Perú - Predicción precoz de severidad en pancreatitis aguda. 2012;32(3):241-50.

Villacís X, Calle P, Patiño J, Calle G. Score BISAP validation as a prognostic system in acute pancreatitis. Rev Gastroenterol Peru 2011;31:230-5.

Bezmarević M1, Kostić Z, Jovanović M, Micković S, Mirković D, Soldatović I, et al. Procalcitonin and BISAP score versus C-reactive protein and APACHE II score in early assessment of severity and outcome of acute pancreatitis. Vojnosanit Pregl. 2012;69(5):425-31.

Guzmán Calderon E, Montes Teves P, Monge Salgado E. Bisap-O: obesity included in score BISAP to improve prediction of severity in acute pancreatitis. Rev Gastroenterol Peru. 2012;32(3):251-6.