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Prognostic Value of the Systemic Inflammatory Response Syndrome (SIRS), BISAP Scale and HAPS in Patients With Acute Pancreatitis.
Antonio Ramos*, Carmina Diaz Zorrilla, Samantha Corro Diaz Gonzalez, Fernando Cordera
Hospital Español, Veracruz, Mexico
Acute pancreatitis (AP) is a disease associated with high mortality in severe cases. The ability to predict severity can help identify patients at high risk of complications and mortality. The ideal predictor should be quick, reproducible, inexpensive, minimally invasive and accurate. The different scales of severity do not fulfill all criteria and some have not proven to be reliable indicators of clinical outcome. The Systemic Inflammatory Response Syndrome (SIRS), the Bedside Index for Severity in Acute Pancreatitis (BISAP) and the Harmless Acute Pancreatitis Score (HAPS) are instruments that allow early prognosis of severity or favorable evolution of AP. The variables required for these instruments are available in all settings, quick to assess, reproducible and inexpensive.
Objective: Identify the usefulness of these scales as early predictors of severity or positive outcome in patients with AP.
Methods: From August 2012 to June 2013, 74 consecutive patients with a diagnosis of AP were admitted and prospectively evaluated.
Results:. 4 patients were excluded. Forty seven were women (67%) and 23 (33%) men, mean age was 40 +/- (17.64. BMI was 27 +/- (6.34. According to the revised Atlanta classification for AP, the severity was classified as Mild 48 (69%), Moderately Severe 8 (11%) and Severe 14 (20%). At admission, 21 patients (30%) had SIRS. Fourteen (20%) continued with SIRS > 24 hrs. Thirty four (49%) patients had BISAP 0, 23 (33%) BISAP 1, 11 (16%) BISAP 2, 1 (2%) BISAP 3. Thirty-two (46%) had HAPS at the time of admission. The presence of HAPS had a sensitivity (SENS) of 46.8%, specificity (SPE) of 59.1%, positive predictive value (PPV) 70.9% and negative predictive value (NPV) 34.2% to predict Mild AP. BISAP 0 to predict mild AP had a SENS 60.8%, SPE 72.7%, PPV 82.3% and NPV 47.1%. Presence of SIRS on admission to predict Severe AP had a SENS 35.7%, SPE 71.4%, PPV 23.8% and NPV of 81.6%. Using the original Atlanta classification where AP was classified as mild or severe, the presence of HAPS has a SENS 50%, SPE 70%, PPV 83.4% and NPV of 31.6% to predict mild AP. BISAP 0 SENS 61.1%, 83.3% SPE, VPP 91.6%, VPN 41.6% to predict mild AP. SIRS present >24hrs since admission had a SENS 64.7%, SPE 94.3%, PPV 78.6%, VPN 89.3% to predict severe AP.
Conclusions: SIRS, BISAP and HAPS are limited predictors of outcome of AP in our series. The current classification of Atlanta diminishes the usefulness of these prognostic scales designed prior to its revision. Using the first classification the predictive value of these scales improves. The presence of SIRS for more than 24 hrs., obesity and / or comorbidities are associated with severity.
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