Siddarth, S (2020) A Comparative study between BISAP and APACHE II Score in Assessing the Severity of Acute Pancreatitis in Chengalpattu Medical College. Masters thesis, Chengalpattu Medical College and Hospital, Chengalpattu.
|
Text
220100620siddarth.pdf Download (1MB) | Preview |
Abstract
BACKGROUND: Acute pancreatitis is a common disorder with substantial burden on the healthcare system. Acute pancreatitis includes wide spectrum of disease varying from mild self-limiting symptoms to fulminant multi organ failure and high mortality. The overall mortality rate is 3-10%, wherein 11-30% of cases are with severe disease manifested as pancreatic necrosis. In 1889, Reginald Fitz described the classic clinico-pathological features of acute pancreatitis and opined about the ineffectiveness and hazards of early operative intervention. The rationale behind the assessment of severity is mainly for practical purpose, where mild pancreatitis responds to supportive measures well but severe pancreatitis requires intensive monitoring of various parameters, specific therapeutic interventions and it has guarded prognosis. Since 1974, several scoring systems have been developed clinically and radiologically for this purpose, including Ranson’s criteria, the acute physiology and chronic health evaluation (APACHE II) score, Medical Research Council Sepsis Scoring (MRCS) and Bedside Index for Severity in Acute Pancreatitis (BISAP). Current methods of stratification of risk factors in acute pancreatitis have much important limitations. The Ranson’s and Modified Glasgow score (IMRIE’s) contains data which are not routinely collected during hospitalization. Both these study require 48 hrs to complete, thereby minimizing the most precious early therapeutic window period. The most commonly used APACHE II scoring system however was originally formulated as an intensive care instrument, which required a large number of parameters to be collected, some of them may not be relevant to prognosis. An ideal prognostic method should be able to differentiate between patients with mild & severe disease, easy to use, and widely available and should be accurate, and should have low interobserver variability. It should also be able to apply early in disease process so that patient who could prone to develop potential complications will be closely monitored and treated if possible empirically. AIMS & OBJECTIVES OF THE STUDY: 1. To evaluate the role of BISAP score in place of traditional APACHE II scoring system in analyzing severity and early treatment intervention. 2. Stratification of the patients with acute pancreatitis according to their scores observed at the time of hospitalization. 3. To correlate the outcome of the study with the scores observed, in terms of disease severity and mortality. Materials and Methods: Study design: Comparative Analytical study. Source of data: Study is a prospective type which will include all patients who will be admitted in CHENGALPATTU MEDICAL COLLEGE with for ACUTE PANCREATITIS. The study will be conducted during the period of December 2017 to December 2019. METHODS OF COLLECTION OF DATA: Study type: Prospective study. Inclusion criteria: • Age > 20 years including both sexes. • Serum amylase/ Serum lipase equal to or more than 3 times the upper limit of normal. • Radiological evidence of presence of acute pancreatitis. Exclusion criteria: • Patients were excluded from the study if they were younger than 20 years. • Proven cases of chronic pancreatitis. • Hereditary pancreatitis. • Patients with comorbidities like COPD, renal impairment, immunosuppressive state, etc. • Traumatic pancreatitis associated other visceral injuries. METHODS: First 100 patients attending the surgical emergency ward with clinical features of Acute Pancreatitis will be evaluated clinically and subjected to laboratory and radiological investigations as per the designed proforma. Data pertinent to the scoring systems will be recorded within 24 h of admission to the hospital. Once diagnosis is established the patient disease severity will be assessed by following two scoring systems: BISAP, APACHE II. Statistical Analysis: Appropriate statistical tools. For each of 100 patients included in the study, APACHE II and BISAP scores will be calculated by using the APACHE II prognostic system in the manner described by Knaus et al and the Cardinal Health Database system for BISAP scoring. Patients will be classified to have mild or severe acute pancreatitis according to the definitions set by the Atlanta Classification guidelines (1992)42: Severe attack--Criteria for severity included: 1) presence of one or more local complications: Pancreatic necrosis, Pancreatic abscess, Pancreatic pseudo cyst. 2) Presence of one or more organ failures: Shock (systolic BP< 90 mm Hg). Pulmonary insufficiency (PaO2< 60 mm Hg on room air). Renal failure (Sr. creatinine > 2mg/dl after fluid replacement). Gastrointestinal bleeding (> 500 ml estimated loss of blood within 24 hrs.). DIC (thrombocytopenia and hypofibrinogenemia and fibrin split products). Severe hypocalcemia (<8 mg/dl). Survivors will be defined as patients discharged alive from the hospital and non-survivors are those who died from pancreatitis or its complications during hospitalization. Biliary Pancreatitis is presence of gall stones/biliary sludge in the gall bladder or bile duct, which will be documented by any radiological methods. Alcoholic Pancreatitis will be considered, when the patient is found to have regular high intake of alcohol daily, or if there is binge of alcohol consumption prior to the onset of illness and has no signs of other etiologies present. Idiopathic pancreatitis is the one with no identifiable etiological factor based on the history, or after initial investigations. Patients will be observed prospectively until discharge or death. APACHE II score of ≥ 9 and BISAP score of ≥ 3 will be expected to predict severe Acute Pancreatitis. CONCLUSION: To compare the efficacy of BISAP and APACHE II scoring systems in assessing the severity of Acute pancreatitis. Most common age group affected with the disease. Overall mortality in patients with severe acute pancreatitis.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | BISAP and APACHE II Score, Assessing the Severity, Acute Pancreatitis, Chengalpattu Medical College. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Feb 2021 17:33 |
| Last Modified: | 10 Feb 2021 17:33 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14009 |
Actions (login required)
 |
View Item |
