Comparison between Bisap Score and Balthazar Score in Prognosis of

Acute Severe Pancreatitis

Article History
Received: 25.10.2020; Revision: 18.11.2020; Accepted: 25.11.2020; Published: 30.11.2020
Author Details
Dr. Supraja Subramanian, Dr.Shubha N Rao and Dr. Reshmina Chandni Clara Dsouza
Authors Affiliations
1Department of General Surgery, Father Muller Medical College, Mangalore, India
2Professors and Unit Chief Department Of General Surgery, Father Muller Medical College, Mangalore, India
3Professor Departments of General Surgery, Father Muller Medical College, Mangalore, India

Abstract:
Keywords:

INTRODUCTION
Acute abdomen is one of the most common complaints that a patient presents to the emergency. Among the
surgical causes of acute abdomen of non- traumatic origin pancreatitis is considered second most severe pain related
problem preceded by abdominal colic. [1]
There are various studies that have been done on the scoring systems and their overall effect in clinical practice; yet,
there are very few studies that have compared the Balthazar scoring system and the CTSI score and the BISAP scoring
system. As one is a radiological and the other is completely based on clinical and laboratory evaluation.
In view of this it was decided to carry out to study to compare the Balthazar scoring system with the CTSI scoring
system so that this study could help in supplementing the existing data and compare the superiority of scoring system
over other.

MATERIALS AND METHODS

A retrospective studywas conducted on the records of patients presenting with acute severe pancreatitis admitted to
various surgical units of father Muller Medical College and Hospital between October 2018 To October 2020. BISAP
score and BALTHAZAR scores were calculated as per criteria highlighted in the literature. 28 case records of acute
severe pancreatitis were identified.

RESULTS
In the present study we had 24 (85.7%) males and 4 (14.3%) females ,chi-square p = 0.02 there was very
significant difference in the distribution of pancreatitis across genders The most common age group was between 21-30
years as the with 9 cases32.14% of the study subjects .The male gender was more susceptible as compared to the female .
this is possible because of the etiology od pancreatitis being alcohol and males have a higher incidence of alcoholism in
the Indian set up. p value =0.011 highly significant The mean age in cases with acute pancreatitis as a result of gall stones
was higher 48.5 years, as compared to those with acute pancreatitis as a result of ethanol consumption 34.56 years
There was a significant association between Glasgow score and outcome with a p value. .0433 at score 7 100% had
mortalityThere was a significant association between ransoms score and outcome with a p value.014. There was a
significant association between Ransons score and outcome with a p value. 0.033 At score 8, 100% had mortality.There
was a significant association between IMRI score and outcome with a p value. 02.
There was a significant association between ransoms score and outcome with a p value.049 at score 6, 100% had
mortalityThere was a significant association between BISAP Score and outcome with a p value < 0.05 at BISAP Score
5 mortality was 14.3% . BISAP had a Sensitivity was 93 .00% and Specificity was 58.00% Balthazar at grade 4
Sensitivity was 95 %and Specificity was 70 0.00% CTSI at 7 Sensitivity was 95.95% and Specificity was 72 .00%
Ransons at 9 Sensitivity was 86.92% and Specificity was 53.33% .Glascow at 4 Sensitivity was 89.09% and Specificity
was 65.88%Mortality rate was 3.57 %.

DISCUSSION
Acute pancreatitis is a very common problem that has very huge impact on the healthcare system and the social well
being of an individual. [2] Overall this disease has a wide spectrum of presentation that ranges from a very mild self-
limiting disease to a severity variety that includes multi organ failure and death. It is estimated that the overall rate of
mortality in a case of acute pancreatitis varies between 3% to 10%. [3]
This rate of mortality can rise very high up to 30% in case of severe form of the disease. As the disease has a wide
variety of presentation it is understandable that the management of the disease depends upon the severity of the disease.
This statement also states the need for assessing the disease severity. [4] [5]
So it also has to be understood that though the disease can be managed with fluid resuscitation and support care most
of the times there are very severe forms of the disease that require high nutritional support in the form of enteral and
parenteral nutrition and other non operative care including a intensive care monitoring . Those patients who have a
severe form of the disease have patients have a risk of rapid deterioration. [6] [7] All this together shows how important it is
to assess the disease severity in a case of acute severe pancreatitis.
In view of all the above said , over the years especially in the late 20 th century various classification systems and
scoring systems have been put into place to assess the severity of acute pancreatitis for clinicians. Some of the
commonly used scoring systems are the Apache scoring system, the BISAP system, the CTSI and the Ransons criteria. [8]
[9]

Each of the scoring systems has their own limitations in terms of sensitivity, specificity and complexity. In 2008 in a
study done in USA was proposed for assessing the disease severity of pancreatitis on the basis of a retrospective study
that on a large population the BISAP scoring system was introduced. According to the system, a five-point scoring that
includes parameters like blood urea nitrogen,, mental status ,the systemic inflammatory response syndrome , age more
than 60 years and pleural effusion was proposed. [10] In the CT severity the Balthazar scoring system proposed it is
shown that these parameters that is; the extent of pancreatic and extrapancreatic fluid collections and pancreatic necrosis
are very important prognostic indicators of assessing the severity in acute pancreatitis and hence using them can improve
the diagnostic accuracy. [11]

CONCLUSION
We concluded that in evaluating the progress in cases of acute severe pancreatitis the objectives of the study were as
follows we concluded that both the CTSI and Balthazar score are good to assess the prognosis of patients considering
both the scores. Both have an almost equal accuracy and specificity, but Balthazar 93.70% has a better than BISAP
92.00%.

REFERENCES
1. Macaluso CR & McNamara RM. Evaluation and management of acute abdominal pain in the emergency
department. International journal of general medicine, 2012; 5:789.
2. Trentzsch H, Werner J & Jauch KW. Acute abdominal pain in the emergency department-a clinical algorithm for
adult patients. Zentralblatt fur Chirurgie, 2011; 136(2):118.
3. Fonseca Sepúlveda EV, Guerrero-Lozano R. Acute pancreatitis and recurrent acute pancreatitis: an exploration of
clinical and etiologic factors and outcomes. J Pediatr (Rio J). 2019; 95(6):713-719.
4. Zerem E. Treatment of severe acute pancreatitis and its complications. World J Gastroenterol. 2014; 20(38):13879-
13892.
5. Hastings RS & Powers RD. Abdominal pain in the ED: a 35 year retrospective. The American journal of emergency
medicine, 2011; 29(7):711-716.
6. Cartwright SL & Knudson MP. Diagnostic imaging of acute abdominal pain in adults. American family
physician, 2015; 91(7):452-459.
7. Cho JH, Kim TN, Chung HH & Kim KH. Comparison of scoring systems in predicting the severity of acute
pancreatitis. World journal of gastroenterology: WJG, 2015; 21(8):2387.
8. Sharma V, Rana SS, Sharma RK, Kang M, Gupta R & Bhasin DK. A study of radiological scoring system
evaluating extrapancreatic inflammation with conventional radiological and clinical scores in predicting outcomes in
acute pancreatitis. Annals of gastroenterology: quarterly publication of the Hellenic Society of
Gastroenterology, 2015; 28(3):399.
9. Harshit Kumar A, Singh Griwan M. A comparison of APACHE II, BISAP, Ranson's score and modified CTSI in
predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification. Gastroenterol Rep
(Oxf). 2018; 6(2):127-131.
10. Chen L, Lu G, Zhou Q & Zhan Q. Evaluation of the BISAP scores in predicting severity and prognoses of acute
pancreatitis in Chinese patients. International surgery, 2013; 98(1):6-12.
11. Bollen TL, Singh VK, Maurer R, Repas K, Van Es HW, Banks PA & Mortele KJ. A comparative evaluation of
radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. American Journal of
Gastroenterology, 2012; 107(4):612-619.