Acute pancreatitis is a clinical puzzle, that continues to have clinicians and researchers befuddled and searching for more viable solutions. While patients that are assumed to be mild cases detoriate rapidly in an unexpected manner, the outcomes for cases deemed serious present with varying in-hospital courses: that include the development of complicaitons, ICU stay and mortality. Such a variable and unpredictable clinical course has encouraged researchers to identify markers of serious disease. Interventional studies have targeted patients with predicted severe pancreatitis. However, predicted severe pancreatitis has varying definitions ranging from various APACHE scores to C-reactive protein levels to clinical findings, such as abnormal chest roentgenography. Unfortunately, diversity of clinical presentations makes it challenging to identify which groups of patients benefit from specific therapy. Additionally, while objective acute pancreatitis outcomes such as death are fortunately rare this necessitates the use of surrogate measures such as clinical improvement or changes in cytokine levels as study endpoints. The use of scoring systems that predict severity of disease have predominated in the acute pancreatitis field. However, there has been a limitation in quantitative scoring systems that encompass the overall physiologic status of the patient for studies. The study of other disease states including inflammatory bowel disease has benefited from the development of quantitative scoring systems such as the Crohn’s Disease Activity Index that can be used to monitor the disease activity during its course. To address this need, a group of international experts recently developed the dynamic acute Pancreatitis Activity Scoring System (PASS). A key step in validating any new disease assessment tool is to evaluate the relationship between the scoring system and clinical outcomes. Outcomes that are deemed crucial in acute pancreatitis include the development of transient or persistent organ failure (moderately severe and severe pancreatitis) as well as local complications, such as pseudocysts and walled off pancreatic necrosis.
Our aim is to compare the PASS score and an already established BISAP score in the prediction of severity of acute pancreatitis based on pertinent clinical outcomes. India has one of the highest cases of acute pancreatitis worldwide (highest worldwide incidence as well as mortality in 2019*) and prevalence rate for Pancreatitis in India is 7.9 per 100,000. Prevalence rate for men and women 8.6 and 8.0 per 100,000 respectively in India. If the PASS score is indeed as helpful as visualized in predicting which patients have a higher chance of severe disease, it can be included in our institutional protocols for the management of acute pancreatitis and early identification of sick patients will help direct treatment more effectively and reduce the morbidity and mortality, benefiting the patient. |