The role of the BISAP score in predicting acute pancreatitis severity according to the revised Atlanta classification: a single tertiary care unit experience from Turkey

Background/Aims: In this study, we examine the utility of Bedside Index of Severity in Acute Pancreatitis (BISAP), which is an increasingly more commonly used simple and practical novel scoring system for predicting the prognosis and severity of the disease at presentation. Materials and methods: Consecutive patients diagnosed with AP between January 2013 and December 2020 were evaluated retrospectively. The AP severity was assessed using the revised Atlanta classification (RAC). BISAP score, demographic characteristics, pancreatitis etiology, pancreatitis history, duration of hospital stay, and mortality rates of the patients were recorded. Results: A total of 1000 adult patients were included, of whom 589 (58.9%) were female and 411 (41.1%) were male. The mean age in female and male patients was 62.15 ± 17.79 and 58.1 ± 16.33 years, respectively (p >0.05). The most common etiological factor was biliary AP (55.8%), followed by idiopathic AP (23%). Based on RAC, 389 (38.9%), 418 (41.8%), and 193 (19.3%) patients had mild, moderate, and severe AP. Of the 1000 patients, 42 (4.2%) died. Significant predictors of mortality included advanced age (>65 y) (p=0.003), hypertension (p=0.007), and ischemic heart disease (p=0.001). A BISAP score of ≥3 had a sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 79.79%, 91.57%, 69.37%, and 94.99%, respectively, for determining SAP patients according to RAC. Conclusion: BISAP is an effective scoring system with a high NPV in predicting the severity of AP in the early course of the disease in a Turkish population.

The revised pancreatitis etiology-based classification system TIGAR-O, version 2: adaptation for the Russian clinical practice

The discoveries in molecular genetics and breakthrough visualization techniques in the last 20 years have changed our understanding of the pancreatitis causes and biomarkers, expanded our knowledge on the pathophysiology of the disease, and promoted the development of new additional conservative treatments. From the practical perspective, the physician's comprehension of the etiology is of particular importance. It is for this reason that the activities to elaborate an etiology-based classification of pancreatitis have been already started since long ago. The first internationally acknowledged system was TIGAR-O checklist, introduced in 2001. Being innovative at the time, it structured our understanding of the etiology of chronic pancreatitis. The revised version (version 2) was published in 2019 and is less known to the Russian medical community, although from the authors' point of view, it has been substantially extended and structured to be maximally convenient and useful for physicians in routine medical practice. The review presents key provisions of the TIGAR-O, version 2 and recommendations for its adaption to the Russian clinical setting.

Incidence and risk factors of oral feeding intolerance in acute pancreatitis: results from an international, multicenter, prospective cohort study

Background Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical outcomes. The factors related to oral feeding intolerance are not well studied. Objective We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis. Methods Patients were prospectively enrolled in the Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience (APPRENTICE), an international acute pancreatitis registry, between 2015 and 2018. Oral feeding intolerance was defined as worsening abdominal pain and/or vomiting after resumption of oral diet. The timing of the initial feeding attempt was stratified based on the day of hospitalization. Multivariable logistic regression was performed to assess for independent risk factors/predictors of oral feeding intolerance. Results Of 1233 acute pancreatitis patients included in the study, 160 (13%) experienced oral feeding intolerance. The incidence of oral feeding intolerance was similar irrespective of the timing of the initial feeding attempt relative to hospital admission day ( P = 0.41). Patients with oral feeding intolerance were more likely to be younger (45 vs. 50 years of age), men (61% vs. 49%) and active alcohol users (44% vs. 36%). They also had higher blood urea nitrogen (20 vs. 15 mg/dL; P<0.001) and hematocrit levels (41.7% vs. 40.5%; P = 0.017) on admission; were more likely to have a non-biliary acute pancreatitis etiology (69% vs. 51%), systemic inflammatory response syndrome of 2 or greater on admission (49% vs. 35%) and at 48 hours (50% vs. 26%;), develop pancreatic necrosis (29% vs. 13%), moderate to severe acute pancreatitis (41% vs. 24%) and have a longer hospital stay (10 vs. 6 days; all P<0.04). The adjusted analysis showed that systemic inflammatory response syndrome of 2 or greater at 48 hours (odds ratio 3.10; 95% confidence interval 1.83–5.25) and a non-biliary acute pancreatitis etiology (odds ratio 1.65; 95% confidence interval 1.01–2.69) were independent risk factors for oral feeding intolerance. Conclusion Oral feeding intolerance occurs in 13% of acute pancreatitis patients and is independently associated with systemic inflammatory response syndrome at 48 hours and a non-biliary etiology.