Role of bedside pancreatic scores and C-reactive protein in predicting pancreatic fluid collections and necrosis.
BACKGROUND
Acute pancreatitis is a disease with variable outcome; the course of the disease can be modified by early aggressive management in patients with severe pancreatitis. Easily calculable pancreatic scores and investigations can help to triage these patients. We aimed to determine the role of bedside index for severity in acute pancreatitis (BISAP), harmless acute pancreatitis score (HAPS), and systemic inflammatory response syndrome (SIRS) scores on day of admission and C-reactive protein (CRP) at 48 h for predicting the presence of pancreatic fluid collection (PFC) and necrosis on CT scans done at 72 h.


METHODS
Of a total of 114 consecutively seen patients of pancreatitis, 64 with acute pancreatitis were enrolled in the study. All individuals had the pancreatitis predicting scores calculated at the time of admission, CRP at 48 h, and contrast-enhanced computed tomography (CECT) abdomen at 72 h from admission.


RESULTS
The study population of 64 (55 male) had a mean (+SD) age of 37.7 ± 13 years. Alcohol was the most common (68.8%) etiology in these patients. Based on CECT, patients were divided into 2 groups; group 1 with 41 patients who had mild pancreatitis and group 2 with 23 patients who had pancreatic fluid collection with or without necrosis (PFCN). PFCN were seen in 19 (29.7%) of patients with 2 or more SIRS criteria, 17 (26.6%) of patients with BISAP score ≥3, and 16 patients (25.0%) with HAPS >0 respectively. All three scores were able to predict PFCN significantly. CRP >150 mg/L was noted in 23 patients and was able to predict the presence of fluid collections (p=0.0002) and pancreatic necrosis (p = 0.0004) on CT.


CONCLUSIONS
BISAP, HAPS, and SIRS scores and CRP of 150 mg/L all correlated significantly with the occurrence of fluid collections and pancreatic necrosis on CT at 72 h. None of the scores was superior to the other in this respect.
Institute of Gastroenterology, SRM Institutes for Medical Sciences, 1 Jawaharlal Nehru Road, Vadapalani, Chennai, 600 026, India. vinishbabu@rediffmail.com.
Doraiswami Babu
DB
Vinish
Department of Gastroenterology, St. Johns Medical College, Sarjapur Road, Bengaluru, 560 034, India.
Vishnu
V
Abishek
Department of Community Medicine, Coimbatore Medical College, Avinashi Road, Peelamedu, Coimbatore, 641 018, India.
K
K
Sujatha
Institute of Gastroenterology, SRM Institutes for Medical Sciences, 1 Jawaharlal Nehru Road, Vadapalani, Chennai, 600 026, India.
S
S
Arulprakash
Kilpauk Medical College, Government Peripheral Hospital, 822, Poonamallee High Road, Kilpauk, Chennai, 600 010, India.
Rajkumar
R
Solomon
Sri Ramachandra Medical College, 1, Ramachandra Nagar, Porur, Chennai, 600 116, India.
P
P
Ganesh
D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D006801:Humans; D008297:Male; D009336:Necrosis; D010179:Pancreas / Q000473:pathology*; D010189:Pancreatic Juice; D010195:Pancreatitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013048:Specimen Handling; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D015415:Biomarkers; D002097:C-Reactive Protein
Acute pancreatitis; BISAP; C-reactive protein; HAPS; SIRS