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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 6
Jun.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(6): 1386-1391

Value of modified objective Bedside Index for Severity in Acute Pancreatitis score in predicting the severity and prognosis of acute pancreatitis

DOI: 10.3969/j.issn.1001-5256.2021.06.032
  • 1.

    Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China

  • 2.

    Institute of Hepatobiliary, Pancreatic, and Intestinal Diseases, North Sichuan Medical College, Nanchong, Sichuan 637000, China

  • Received Date: 2020-11-15
  • Accepted Date: 2020-12-18
  • Published Date: 2021-06-20
    Abstract
  •   Objective  To investigate the value of modified objective Bedside Index for Severity in Acute Pancreatitis (BISAP) score (MBISAP) in predicting the severity and prognosis of acute pancreatitis (AP).  Methods  A retrospective analysis was performed for the data of 313 patients with AP who were treated in Affiliated Hospital of North Sichuan Medical College from June 2018 to June 2020, and the subjective indicator of mental state in BISAP score was removed. According to the scoring criteria for Computed Tomography Severity Index (CTSI), the degree of pancreatic necrosis was classified as 4 grades (0%, 0%-30%, 30%-50%, and > 50%) and was assigned a score of 0-3 points, respectively, and MBISAP score was determined by adding the above points, with the highest score of 7 points. According to the receiver operating characteristic (ROC) curve, the 313 patients with pancreatitis were divided into low-level MBISAP group (MBISAP < 3) and high-level MBISAP group (MBISAP ≥3). The two groups were compared in terms of baseline data and clinical outcome. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. The area under the ROC curve (AUC) was used to analyze an compare the value of MBISAP score, BISAP score, and CTSI score in predicting the severity and prognosis of AP.  Results  There were significant differences between the two groups in age (Z=-5.480, P < 0.001), etiology (χ2=36.536, P < 0.001), length of hospital stay (Z=-6.038, P < 0.001), mortality rate (P < 0.001), peripancreatic infection (P < 0.001), multiple organ dysfunction syndrome (MODS) (P < 0.001), BISAP score (χ2=215.320, P < 0.001), and CTSI score (P < 0.001). Severity of AP, mortality rate, and incidence rates of peripancreatic infection and MODS tended to increase with the increase in MBISAP score (P < 0.001). In predicting severe AP, MBISAP score had an AUC of 0.898 (95% confidence interval [CI]: 0.859-0.929, P < 0.001), with a sensitivity of 71.43% and a specificity of 90.53%; at the optimal cut-off value of ≥3, MBISAP score was significantly better than BISAP score (AUC=0.868) and CTSI score (AUC=0.827) (both P < 0.05). In predicting the mortality of patients with AP, MBISAP score had an AUC of 0.925 (95% CI: 0.890-0.952, P < 0.001), with a sensitivity of 88.89% and a specificity of 82.89%; at the optimal cut-off value of ≥3, MBISAP score was similar to BISAP score (AUC=0.915) and CTSI score (AUC=0.879) (both P > 0.05). In predicting peripancreatic infection in AP, MBISAP score had an AUC of 0.842 (95% CI: 0.796-0.880, P < 0.001), with a sensitivity of 72.22% and a specificity of 84.07%; at the optimal cut-off value of > 2, MBISAP score was better than BISAP score (AUC=0.776) and was inferior to CTSI score (AUC=0.932) (both P < 0.05). In predicting MODS in patients with AP, MBISAP score had an AUC of 0.874 (95% CI: 0.832-0.909, P < 0.001), with a sensitivity of 76.19% and a specificity of 84.93%; at the optimal cut-off value of > 2, MBISAP score was similar to BISAP score (AUC=0.855) and CTSI score (AUC=0.829) (both P > 0.05).  Conclusion  MBISAP score is better than BISAP score in predicting the severity of AP patients and peripancreatic infection, and it also has a good value in predicting mortality and MODS in patients with AP. MBISAP score can evaluate the conditions of AP patients more accurately and objectively than BISAP score.

     

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