Abstract

Dr. Sudhanshu Tripathi* and Dr. V. V. Kanase

ABSTRACT

Background and objective: Pancreatitis is an inflammation of glandular parenchyma resulting in injury or destruction of acinar cells. The pathologic process can cause a self-regulating disease with no sequelae or may initiate catastrophic auto digestion activity with systemic cytotoxic effects and serious complications in the acute form. The clinical sign of pancreas-related abdominal pain associated with variations of serum amylase and lipase led to the term pancreatitis. The recent observations obtained by imaging studies, including ultrasound, CT, and MRI, should discourse the required treatment patient by patient. The initial stage is extremely difficult to diagnose, but also important to provide the right medical or surgical choice. Only the active surveillance of patients with controlled follow-up permit us to classify pancreatitis and to outline the disease better, assigning the decisive labels supported by the biochemical and radiologic sources well categorized by the different classification systems present. The clinical sequence of acute pancreatitis fluctuates from a mild transitory form to a severe necrotizing disease. Majority of the episodes of acute pancreatitis (80%) are mild and self-limiting, settling spontaneously in 3 to 5 days. Recent statistics indicate a rise in number along with rate of out emergency department visits, hospital admissions and direct healthcare costs for Acute Pancreatitis. With an estimated mortality rate of 2-5%, a reliable method of risk stratification for Acute Pancreatitis is of substantial clinical importance. The Ranson and modified Glasgow score contain data not routinely collected at time of hospitalization. In addition, both require 48 hours to complete, neglecting a potentially valuable early therapeutic window. The most commonly used to predict scoring system for clinical studies in Acute Pancreatitis is the Acute Physiology and Chronic Health Examination (APACHE) II score. However, the APACHE II was primarily developed as an intensive care instrument and entails the collection of a large number of parameters, some of which may not be related to prognosis in Acute Pancreatitis. The reason of this study was to develop a simple and precise clinical scoring system for classifying patients according to the risk of in hospital mortality. To develop a clinical tool useful in initial course of disease, we will examine data collected within the first 24 h of hospitalization. Methods: This study is a prospective hospital based time bound study concerning patients of Acute Pancreatitis admitted in Krishna Institute of Medical Sciences from December 2016-June 2018. Information was collected from detailed history, clinical examination and investigation (both hematological and radiological) on the patients. A total of 92 patients of Acute Pancreatitis were studied. Result: In this study among 92 cases, there were 6 (6.52 %) deaths. There was a statistically significant tendency for increasing mortality (P < 0.0001) with increasing BISAP score. The area under the receiver operating curve for mortality by BISAP score in the prospective cohort was 0.938 (95 % confidence interval: 0.862, 1.00). Fischer’s exact test value of 19.263 is also significant. This outcome is in coherence with other studies previously done and thus establishing the significance of BISAP as a simple and accurate predictor of mortality. Summary and Conclusion: BISAP SCORE evaluation is found to be very simple and accurate method of predicting mortality in the Acute pancreatitis in Observational Analytical Prospective Cohort Study included 92 patients presented with acute pancreatitis and were given the score from 0 to 5 on the basis of five simple variables. These were BUN, Impaired mental status, SIRS, Age and Pleural Effusion. All these parameters were easy to evaluate and were routinely done in our hospital for patients admitted with Acute Pancreatitis. Statistically significant trend in mortality was found with increasing BISAP. No mortality was seen in group with score 0 whereas there was 66% mortality in cluster of patients with score 4. Overall stay period in the hospital increases with increase in BISAP score. Male to female ratio in our group of patients showed male preponderance with a ratio of 2.57:1. With majority of the patients were in age group between 21-39. Among the various etiologies of Acute Pancreatitis, our study showed alcohol induced pancreatitis as the most common cause, with 34% of patients presenting with this association. This is mainly due to the male preponderance of our study. Gall stone pancreatitis was also a significant cause, as 27% of patients have this association. 8% of patients presented with Post ERCP induced pancreatitis thus stressing the complication associated with the procedure.