EARLY PREDICTION OF SEVERE ACUTE PANCREATITIS: COMPARATIVE VALIDATION OF BISAP AND RANSON SCORING SYSTEMS IN A PROSPECTIVE COHORT

Abstract

Background: Acute pancreatitis is a common gastrointestinal emergency with a highly variable clinical course ranging from mild, self-limiting inflammation to severe disease complicated by persistent organ failure and mortality. Early identification of patients at risk of severe acute pancreatitis is crucial for timely intervention, appropriate triage, and optimal utilization of healthcare resources. Among the available prognostic tools, the Bedside Index for Severity in Acute Pancreatitis (BISAP) and Ranson’s Criteria are widely used; however, their comparative performance remains a matter of clinical interest.

Methods: This prospective observational study included 50 consecutive adult patients diagnosed with acute pancreatitis at a tertiary care centre. BISAP scores were calculated within the first 24 hours of admission, whereas Ranson’s Criteria were assessed at admission and after 48 hours. Disease severity was compared between the two scoring systems and correlated with etiological factors and biochemical parameters using appropriate statistical analysis, with a p-value <0.05 considered statistically significant.

Results: The study population comprised predominantly males (70%), with alcohol (60%) and gallstone disease (36%) representing the leading etiologies. At 48 hours, hypoxemia and a hematocrit decline >10% were observed in 80% of patients, reflecting substantial systemic involvement. Ranson’s Criteria classified a significantly greater proportion of patients as having severe disease than BISAP (76% vs. 42%; p=0.001). Among patients with gallstone-induced pancreatitis, severe disease was identified in 83.3% by Ranson’s Criteria compared with 44.4% by BISAP. Although disease etiology was not independently associated with severity, Ranson’s Criteria demonstrated greater sensitivity in detecting progressive systemic involvement, particularly in patients with elevated pancreatic enzyme levels.

Conclusions: Both scoring systems are clinically valuable for early risk stratification in acute pancreatitis. BISAP offers a rapid and practical bedside assessment suitable for early triage, whereas Ranson’s Criteria provide a more comprehensive evaluation of evolving disease severity over the initial 48 hours. Their complementary use may facilitate timely clinical decision-making, particularly in resource-constrained healthcare settings.