Akut Pankreatitli Hastalarda Mortaliteyi Öngörmede BAR, BISAP ve NEWS Skorlarının Karşılaştırılması

Yıl 2025, Cilt: 7 Sayı: 2, 85 - 90, 21.07.2025

Mustafa Kürşat Ayrancı , Sami Ataman , Kadir Küçükceran , Mustafa Doğru , Mehmet Ali Çimen

https://doi.org/10.38175/phnx.1707662

Öz

Amaç: Akut pankreatit, yüksek mortalite oranına sahip bir gastrointestinal acil durumdur. Akut pankreatitte mortaliteyi öngörmek için çeşitli biyobelirteçler ve skorlama sistemleri kullanılmaktadır. BISAPS (Bedside Index of Severity of Acute Pancreatitis Score) ve NEWS (National Early Warning Score) gibi geleneksel yöntemler çok fazla parametre içermektedir. Bu çalışmada, acil servise başvuran akut pankreatitli hastalarda BUN/Albümin oranı (BAR) ile mortalitenin öngörülmesi amaçlandı.
Gereç ve Yöntem: 01/01/2021 ile 31/12/2022 tarihleri arasında acil servise başvuran ve lipaz değeri referans değerin üç katından fazla olan hastalar, hastane verileri retrospektif olarak taranarak çalışmaya dahil edildi. Hastalar, hastane içi mortaliteye göre iki gruba ayrıldı. Tüm hastaların BAR, BISAP ve NEWS değerleri hesaplanarak karşılaştırıldı.
Bulgular: Mortaliteyi öngörme gücünü değerlendirmek için yapılan ROC analizinde; AUC değerleri NEWS için 0,637 (0.546-0.727), BISAPS için 0,684 (0.589-0.779), BAR için 0,748 (0.663-0.832) olarak bulundu. Lojistik regresyon analizinde; BAR, akut pankreatitli hastalarda hastane içi mortalitenin en güçlü bağımsız belirleyicisi olarak bulundu. BAR’da 1 birimlik artışın hastane içi mortaliteyi 1,071 kat artırdığı tespit edildi.
Sonuç: Acil servise başvuran akut pankreatitli hastalarda, BAR skoru, NEWS ve BISAPS skorlarına göre mortaliteyi öngörmede daha etkilidir.

Anahtar Kelimeler

Akut Pankreatit , BAR , BISAPS , NEWS , Mortalite

Comparison of BAR, BISAP and NEWS Scores in Predicting Mortality in Patients with Acute Pancreatitis

Öz

Objective: Acute pancreatitis is a gastrointestinal emergency with a high mortality rate. Multiple biomarkers and scoring systems are used to predict mortality in acute pancreatitis. Traditional methods such as BISAPS (Bedside Index of Severity of Acute Pancreatitis Score) and NEWS (National Early Warning Score) contain too many parameters. To predict mortality in patients with acute pancreatitis who apply to the emergency department with the BUN/Albumin ratio (BAR).
Material and Method: Patients who were admitted to the emergency department between 01/01/2021 and 31/12/2022 and whose lipase value was more than three times the reference value were included in our study by retrospectively scanning hospital data.Patients were divided into two groups according to in-hospital mortality. BAR, BISAP and NEWS values of all patients were calculated and compared.
Result: In the ROC analysis performed to evaluate the mortality predictive power; AUC values of NEWS 0.637 (0.546-0.727), BISAPS 0.684 (0.589-0.779), BAR 0.748 (0.663-0.832) were obtained. In the logistic regression analysis; BAR was found to be the highest independent predictor of in-hospital mortality of acute pancreatitis. It was found that a 1 unit increase in BAR increased in-hospital mortality by 1,071 times.
Conclusions: BAR is more effective in predicting mortality than NEWS and BISAPS in patients with acute pancreatitis who present to the emergency department.

Anahtar Kelimeler

Acute Pancreatitis , BAR , BISAPS , NEWS , Mortality

Kaynakça

• Waller A, Long B, Koyfman A, Gottlieb M. Acute Pancreatitis: Updates for Emergency Clinicians. J Emerg Med. 2018;55(6):769-779. doi:10.1016/j.jemermed.2018.08.009
• Venkatesh NR, Vijayakumar C, Balasubramaniyan G, Kandhasamy C, Sundaramurthi S, Sreenath GS, et al. Comparison of Different Scoring Systems in Predicting the Severity of Acute Pancreatitis: A Prospective Observational Study. Cureus. 12(2):e6943. doi:10.7759/cureus.6943
• Pando E, Alberti P, Mata R, Gomez MJ, Vidal L, Cirera A, et al. Early changes in blood urea nitrogen (BUN) can predict mortality in acute pancreatitis: comparative study between BISAP score, APACHE-II, and other laboratory markers—a prospective observational study. Can J Gastroenterol Hepatol. 2021;2021.
• Yucel A, Kilic AO, Kilinc SB. The role of the Inflammatory Biomarkers in the Early Production of the Severity of Paediatric Acute Pancreatitis. Selcuk Med J 2022;38(4): 186-193
• Kumaravel A, Stevens T, Papachristou GI, Muddana V, Bhatt A, Lee PJ, et al. A model to predict the severity of acute pancreatitis based on serum level of amylase and body mass index. Clin Gastroenterol Hepatol. 2015;13(8):1496-1501.
• Anudeep K, Kiliyanari A, Chandran I, Jose P, Mathew J. Prediction of Adverse Outcome and Mortality in Patients with Acute Pancreatitis Using BISAP Scoring System. Int J Life Sci Biotech Pharma Res. 2023;12(2).
• Dundar ZD, Kocak S, Girisgin AS. Lactate and NEWS-L are fair predictors of mortality in critically ill geriatric emergency department patients. Am J Emerg Med. 2020;38(2):217-221.
• Echevarria C, Steer J, Bourke SC. Comparison of early warning scores in patients with COPD exacerbation: DECAF and NEWS score. Thorax. Published online 2019:thoraxjnl-2019-213470.
• Checchio LM, Como AJ. Electrolytes, BUN, creatinine: Who’s at risk? Ann Emerg Med. 1986;15(3):363-366.
• Aronson D, Mittleman MA, Burger AJ. Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure. Am J Med. 2004;116(7):466-473.
• Küçükceran K, Ayrancı MK, Girişgin A, Koçak S, Dundar ZD. The role of the lactate/albumin ratio in predicting mortality in COVID-19 patients in the emergency department. Mevlana Tıp Bilim Derg. 2023;3(1):5-10.
• He WH, Zhu Y, Zhu Y, Jin Q, Xu HR, Xion ZJ, et al. Comparison of multifactor scoring systems and single serum markers for the early prediction of the severity of acute pancreatitis. J Gastroenterol Hepatol. 2017;32(11):1895-1901.
• Koutroumpakis E, Wu BU, Bakker OJ, Dudekula A, Singh VK, Besselink MG, et al. Admission hematocrit and rise in blood urea nitrogen at 24 h outperform other laboratory markers in predicting persistent organ failure and pancreatic necrosis in acute pancreatitis: a post hoc analysis of three large prospective databases. Off J Am Coll Gastroenterol ACG. 2015;110(12):1707-1716.
• Kerner T, Vollmar B, Menger MD, Waldner H, Messmer K. Determinants of pancreatic microcirculation in acute pancreatitis in rats. J Surg Res. 1996;62(2):165-171.
• Dundar ZD, Kucukceran K, Ayranci MK. Evaluation of The Predictive Power of Blood Urea Nitrogen/Albumin Ratio for in-Hospital Mortality in Critically III Patients. Selcuk Univ Med J. 2021;37(4):294-300. doi:10.30733/std.2021.01508
• Lukens FJ, Ko D, Kröner PT, Salazar M, Raimondo M, Argueta PP. Modified Bedside Index for severity in acute pancreatitis (BISAP) score validation in the national inpatient sample database. Adv Med Sci. 2023;68(2):208-212.
• Akcay A, Nguyen Q, Edelstein CL. Mediators of Inflammation in Acute Kidney Injury. Morand E, ed. Mediators Inflamm. 2010;2009:137072. doi:10.1155/2009/137072
• Choi JW, Park JS, Lee CH. Genetically determined hypoalbuminemia as a risk factor for hypertension: instrumental variable analysis. Sci Rep. 2021;11(1):11290. doi:10.1038/s41598-021-89775-3
• Don BR, Kaysen G. Poor Nutritional Status and Inflammation: Serum Albumin: Relationship to Inflammation and Nutrition. Semin Dial. 2004;17(6):432-437. doi:10.1111/j.0894-0959.2004.17603.x
• Zou K, Huang S, Ren W, Xu H, Zhang W, Shi X, et al. Development and Validation of a Dynamic Nomogram for Predicting in-Hospital Mortality in Patients with Acute Pancreatitis: A Retrospective Cohort Study in the Intensive Care Unit. Int J Gen Med. Published online 2023:2541-2553.
• Akyil FT, Yalcinsoy M, Hazar A, Cilli A, Celenk B, Kilic O, et al. Prognosis of hospitalized patients with community-acquired pneumonia. Pulmonology. 2018;24(3):164-169.
• Bae SJ, Lee SH, Yun SJ, Kim K. Usefulness of the blood urea nitrogen-to-serum albumin ratio as a prognostic indicator of severity in acute ischemic stroke. Signa Vitae. 2021;17(4).
• Okşul M, Bilge Ö, Taştan E, Işık F, İnci Ü, Akın H, et al. Evaluation of the effect of bun/albumin ratio on in-hospital mortality in hypertensive COVID-19 patients. Eur Rev Med Pharmacol Sci. 2023;27(5).
• Han T, Cheng T, Liao Y, Tang S, Liu B, He Y, et al. Analysis of the value of the blood urea nitrogen to albumin ratio as a predictor of mortality in patients with sepsis. J Inflamm Res. Published online 2022:1227-1235.
• PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK. BJS Open. 2023;7(3):zrad008.
• Tan JW, Zhang XQ, Geng CM, Peng LL. Development of the National Early Warning Score-Calcium Model for predicting adverse outcomes in patients with acute pancreatitis. J Emerg Nurs. 2020;46(2):171-179.
• Anderson K, Shah I, Yakah W, Cartelle AL, Zuberi SA, McHenry N, et al. Prospective evaluation of an emergency department protocol to prevent hospitalization in mild acute pancreatitis: Outcomes and predictors of discharge. Pancreatology. 2023;23(3):299-305.
• Şenkal, N, Karahan L, Bardak AE, Konyaoğlu H, Teberik Kama E, İnci İ, et al. Akut Pankreatitte Ranson Skorunun Değerlendirilmesi: Acil Servise Başvuru Anında Değeri. İstanbul Tıp Fakültesi Derg. 2023;86(3):198-203. doi:10.26650/IUITFD.1272976