BISAP score- incorporates five clinical and lab parameters obtained within the first 24 hours of admission. a) Blood urea nitrogen (BUN) >25 mg%, b) impaired mental status, c) Glasgow coma score < 15, d) Age >50 years, e) Systemic inflammatory response syndrome (SIRS) – when two or more of the followings are present i.e., i core body temperature <36°C or >38°C, ii heart rate >90/minute, iii respiratory rate >20/minute, iv WBC count <4000 cells/mm3 or > 12000 cells/mm3. Each score is given 1 point. A score of zero was awarded in case of absence of any of these factors. The total BISAP score was calculated within 24 hours. Various possible outcomes of the study were severity, necrosis, organ failure and death.Author(s) Details:
Kanwar Singh Goel
Department of General Surgery, SGT Medical College, SGT University, Budhera, Gurugram, Haryana,
India.
Nikhil Goel
Department of Psychiatry, Shaheed Hasan Khan Mewati Government Medical College, Nuh, India.
Sapna Singla
Department of Pathology, Shaheed Hasan Khan Mewati Government Medical College, Nuh, India.
Recent Global Research Developments in Management of Severe Acute Pancreatitis
- Severity Prediction: Recent studies have shown that serum cytokines can predict the severity of SAP more accurately than traditional laboratory tests and clinical scoring systems [1].
- Fluid Resuscitation: For patients with SAP and vascular leak syndrome, careful administration of intravenous fluids is crucial to prevent intra-abdominal hypertension and volume overload [1].
- Endoscopic Intervention: Endoscopic retrograde cholangiopancreatography (ERCP) has been found to improve outcomes in SAP patients with suspected cholangitis [1].
- Nutrition: Early enteral tube-feeding does not appear to be superior to on-demand oral feeding [1].
- Abdominal Compartment Syndrome: This is a severe complication of SAP that requires percutaneous drainage or decompressive laparotomy [1].
- Step-Up Approach: For patients with symptomatic or infected walled-off pancreatic necrosis, a step-up approach involving endoscopic transmural drainage followed by necrosectomy is preferred [1].
- International Guidelines: The 2019 WSES guidelines emphasize the importance of early identification and management of severe cases, including the use of antibiotics, intensive care, and surgical interventions when necessary [2].
References
- Lee, P.J., Papachristou, G.I. Management of Severe Acute Pancreatitis. Curr Treat Options Gastro 18, 670–681 (2020). https://doi.org/10.1007/s11938-020-00322-x
- Leppäniemi, A., Tolonen, M., Tarasconi, A. et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg 14, 27 (2019). https://doi.org/10.1186/s13017-019-0247-0