BISAP Pancreatitis Score Calculator

How does this BISAP pancreatitis score calculator work?

This is the Bedside Index for Severity in Acute Pancreatitis score and assesses the risk of complications in patients suffering from PA within 24h of presentation.

There are 5 criteria involved, each of them awarded one point if positive. There is an interpretation of the score in regard to pancreatitis severity, risk of necrotic pancreatitis and mortality prediction.

This BISAP pancreatitis score calculator is useful in the early identification of cases which are at risk of hospital mortality and takes account of the following factors:

■ Blood urea nitrogen (BUN) increase higher than 25 mg/dL (8.92 mmol/L) – the amount of waste product nitrogen in the blood is an indicator of kidney, liver but also pancreas function;

■ Impaired mental status (disorientation, lethargy, coma) – acute mental status change is a prevalent symptom in Pa;

■ More than 2 SIRS criteria met (Temperature >38°C, 100°C; HR>90; RR>20 or PaCO₂ 12k) - Systemic Inflammatory Response Syndrome suggestive of a pro inflammatory condition that risks developing into multiple organ failure;

■ Age higher than 60 – age is a risk factor in PA;

■ Pleural effusion – varying in size, interfering with breathing to different degrees is associated with severe pancreatic damage.

Interpreting BISAP score

Causes of Acute Pancreatitis

Most PAs are caused by alcohol or gallbladder stones. Although mostly a condition affecting middle age and elderly persons, it can still occur in people of all ages. Men are more predisposed to suffering from Pa of an alcoholic cause while women of gallstone caused PA.

■ Gallstones (45%);

■ Alcohol (35%);

■ Other (10%) hypercalcemia, hypertriglyceridemia, duct obstruction, endoscopic retrograde cholangiopancreatography, viral infection, vascular ischemia, trauma, idiopathic.

Other models used in assessing pancreatitis

Beside the BISAP score there are other models, some of them more extensive, which try to guide medical management in cases with potentially adverse outcomes:

■ Ranson Criteria – with factors at admission and within 48h from hospitalization;

■ Acute physiology and chronic health examination APACHE II;

■ Computed tomography severity index (CTSI).

These are all useful in predicting complications, the severity of PA, pancreatic necrosis PNec and mortality.

References

1) Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. (2008) The early prediction of mortality in acute pancreatitis: a large population-based study. Gut; 57(12):1698-703.

2) Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. (1974) Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet;139(1):69-81

3) Papachristou GI, Muddana V, Yadav D, O'Connell M, Sanders MK, Slivka A, Whitcomb DC. (2010) Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol; 105(2):435-41