Zhang Jia, Shahbaz Muhammad, Fang Ruliang, Liang Benjia, Gao Chao, Gao Huijie, Ijaz Muhammad, Peng Cheng, Wang Ben, Niu Zhengchuan, Niu Jun
Department of Emergency Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei, China.
Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan, 250012, China.
J Hepatobiliary Pancreat Sci. 2014 Sep;21(9):689-694. doi: 10.1002/jhbp.118. Epub 2014 May 22.
The bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactor scoring system. As there were no studies designed to validate this system according to the latest Atlanta classification in China and more data are needed before clinical application, we compared BISAP, the Acute Physiology and Chronic Health Evaluation (APACHE) II and Ranson scoring systems in predicting the severity, pancreatic necrosis and mortality of acute pancreatitis (AP) using the latest 2012 Atlanta classification in a tertiary care center in China.
The medical records of all patients with AP admitted to our hospitals between January 2010 and June 2013 were reviewed retrospectively. Severe AP was defined as the persistence of organ failure for more than 48 h. The capacity of the BISAP, APACHE II and Ranson's score system to predict severity, pancreatic necrosis and mortality was evaluated using linear-by-linear association. The predictive accuracy of the BISAP, APACHE II and Ranson's score was measured as the area under the receiver operating characteristic curve (AUC).
Of 155 patients enrolled in the study, 16.7% were classified as having severe AP, and six (3.2%) died. There were statistically significant trends for increasing severity (P < 0.001), PNec (P < 0.001) and mortality (P < 0.001) with increasing BISAP. The AUC for severity predicted by BISAP was 0.793 (95% confidence interval [CI] 0.700-0.886), APACHE II 0.836 (95% CI 0.744-0.928) and by Ranson score was 0.903 (95% CI 0.814-0.992). The AUC for PNec predicted by BISAP was 0.834 (95% CI 0.739-0.929), APACHE II 0.801 (95% CI 0.691-0.910) and by Ranson score was 0.840 (95% CI 0.741-0.939). The AUC for mortality predicted by BISAP was 0.791 (95% CI 0.593-0.989), APACHE II 0.812 (95% CI 0.717-0.906) and by Ranson score was 0.904 (95% CI 0.829-0.979).
BISAP score may be a valuable source for risk stratification and prognostic prediction in Chinese patients with AP. A prospective and multicenter validation study is required to confirm our results and further our recognition of BISAP scores in AP.
急性胰腺炎严重程度床边指数（BISAP）是一种新型、便捷的多因素预后评分系统。由于国内尚无根据最新亚特兰大分类法验证该系统的研究，且在临床应用前需要更多数据，我们在中国一家三级医疗中心采用2012年最新亚特兰大分类法，比较了BISAP、急性生理与慢性健康状况评估（APACHE）II和兰森评分系统在预测急性胰腺炎（AP）严重程度、胰腺坏死及死亡率方面的效果。
回顾性分析2010年1月至2013年6月期间我院收治的所有AP患者的病历。重度AP定义为器官功能衰竭持续超过48小时。采用线性关联分析评估BISAP、APACHE II和兰森评分系统预测严重程度、胰腺坏死及死亡率的能力。以受试者工作特征曲线（AUC）下面积衡量BISAP、APACHE II和兰森评分的预测准确性。
本研究纳入的155例患者中，16.7%被归类为重度AP，6例（3.2%）死亡。随着BISAP评分升高，严重程度（P < 0.001）、胰腺坏死（P < 0.001）和死亡率（P < 0.001）呈显著上升趋势。BISAP预测严重程度的AUC为0.793（95%置信区间[CI] 0.700 - 0.886），APACHE II为0.836（95% CI 0.744 - 0.928），兰森评分为0.903（95% CI 0.814 - 0.992）。BISAP预测胰腺坏死的AUC为0.834（95% CI 0.739 - 0.929），APACHE II为0.801（95% CI 0.691 - 0.910），兰森评分为0.840（95% CI 0.741 - 0.939）。BISAP预测死亡率的AUC为0.791（95% CI 0.593 - 0.989），APACHE II为0.812（95% CI 0.717 - 0.906），兰森评分为0.904（95% CI 0.829 - 0.979）。
BISAP评分可能是中国AP患者风险分层和预后预测的重要指标。需要进行前瞻性多中心验证研究以证实我们的结果，并进一步认识BISAP评分在AP中的作用。
