BISAP score
The Bedside Index of Severity in Acute Pancreatitis (BISAP) scoring system incorporates five clinical and laboratory parameters obtained within the first 24 h of hospitalization. This score can be useful in assessing the severity of acute pancreatitis. Parameters are:
- BUN >25 mg/dL
- Impaired mental status (Glasgow coma score < 15)
- SIRS: ≥ 2 of 4 present
- Age >60 years
- Pleural effusion on radiography
Interpretation:
Presence of three or more of these factors was associated with substantially increased risk for in-hospital mortality among patients with acute pancreatitis.
In addition, an elevated hematocrit >44% and admission BUN >22 mg/dL are also associated with more severe acute pancreatitis. Incorporating these indices with the overall patient response to initial fluid resuscitation in the emergency ward can be useful at triaging patients to the appropriate hospital acute care setting.
In general, patients with lower BISAP scores, hematocrits and admission BUNs tend to respond to initial management and are triaged to a regular hospital ward for ongoing care. If SIRS is not present at 24 h，the patients are unlikely to develop organ failure or necrosis. Therefore, patients with persistent SIRS at 24 h or underlying comorbid illnesses (e.g. chronic obstructive pulmonary disease, congestive heart failure) should be considered for a step-down unit setting if available.
Patients with higher BISAP scores and elevations in hematocrit and admission BUN that do not respond to initial fluid resuscitation and exhibit evidence of respiratory failure, hypotension, or organ failure should be considered for direct admission to an intensive care unit.
Source:
- Harrison’s Principles of Internal Medicine 2 volumes 19th Edition; page: 2758 (2096), Table 371-3
- Davidsons Principles and Practice of Medicine 23 edition; page: 838
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