Comparative Study Between Various Scoring Systems in Predicting the Severity of Acute Pancreatitis

Background Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas, peri-pancreatic tissues, and several organs, leading to multiple organ dysfunction syndrome and a higher risk of mortality. For many years, scoring systems that include biochemical, radiological, and clinical criteria for determining severity have been used. Though numerous studies have used various scoring methods to evaluate the severity of AP, this study has been conducted to compare four scoring systems: bedside index of severity in AP (BISAP), acute physiology and chronic health evaluation (APACHE II), Ranson's, and modified CT severity index (CTSI) based on clinical, biochemical, and radiological parameters. Materials and methods It was a prospective-comparative study. The study was conducted from December 2016 to August 2018 in the Department of General Surgery at Byramjee Jeejeebhoy Government Medical College (B.J.G.M.C.) and Sassoon Hospital, Pune, Maharashtra, India. A total of 75 participants were enrolled in the study.  Results The study population ranged from 18 to 68 years, with a mean age of 40.8±11.5 years. AP was most prevalent in the age group of 31-40 years (33.3% cases). Out of 75 patients in this study, 14 patients (18.7%) had severe AP (SAP), 18 patients (24%) had moderate SAP, and 43 patients (57.3%) had mild AP. Ten patients expired, with a mortality rate of 13.3%. It has been observed that the BISAP score had the best specificity (100%) and the CTSI score had the highest sensitivity (96.9%) among our study's four scores for predicting pancreatic necrosis. When predicting persistent organ failure, BISAP had the highest specificity, and Ranson and CTSI scored the highest sensitivity. The modified CTSI poorly predicted AP, patients' mortality, and SAP. Conclusion The BISAP score provides a straightforward and accurate way to analyze the seriousness of AP. Ranson's score is also a reliable indicator of ongoing organ failure among AP cases. The most reliable technique for predicting pancreatitis mortality is the APACHE II score.