Comprehensive Analysis of Etiology, Prognosis, and Clinical Outcome of Acute Pancreatitis: Correlation of BISAP Score and Modified CT Severity Index

Abstract

Background: Acute pancreatitis (AP) is a potentially life-threatening gastrointestinal emergency with variable clinical outcomes. Early and accurate severity stratification is essential to triage patients appropriately and initiate timely intensive management. The Bedside Index for Severity in Acute Pancreatitis (BISAP) and the Modified CT Severity Index (CTSI) are widely used prognostic tools; however, comparative data from tertiary care centres in India remain limited. Methods: An observational cross-sectional study was conducted at the Department of General Surgery, Government Medical College and Hospital, Kota, Rajasthan, from July 2023 to July 2024. Fifty patients with a confirmed first episode of acute pancreatitis (age 18–70 years) were enrolled. BISAP scores were computed within 24 hours of admission. Modified CTSI was calculated from contrast-enhanced CT performed at 48–72 hours. Clinical outcomes assessed included in-hospital complications, mortality, and length of hospital stay. Results: Of 50 patients, 74% were male and mean age was 37.5 ± 10.37 years. Alcohol was the most common aetiology (68%), followed by gallstones (20%) and trauma (8%). BISAP score ≥3 (high risk) was observed in 18% of patients; 82% had a low BISAP score (<3). By Modified CTSI, 72% were mild, 22% moderate, and 6% severe. Eighty percent of patients improved without sequelae, 8% had local complications (pseudocyst, mesenteric thrombosis), 6% had systemic complications (sepsis, ARDS), and mortality was 6% (3 patients). All patients with low BISAP (<3) recovered without complications. BISAP demonstrated sensitivity of 100%, specificity of 95.35%, positive predictive value (PPV) of 77.78%, and negative predictive value (NPV) of 100%. Modified CTSI had sensitivity of 42.86%, specificity of 100%, PPV of 100%, and NPV of 91.49%. Mean hospital stay was 5.08 ± 3.93 days. Conclusion: BISAP score is a superior bedside tool for early severity stratification of acute pancreatitis with higher sensitivity and NPV compared to Modified CTSI. Patients with BISAP <3 can be safely managed at district-level centres without mandatory CT imaging, optimising resource utilisation. Alcohol remains the dominant aetiological factor in this population, warranting targeted public health interventions.

Keywords: Acute pancreatitis, BISAP score, CT severity index, Modified CTSI, severity stratification, prognosis, outcome, alcohol, gallstones