# Understanding Etiopathogenesis and Clinical Outcomes in Acute Pancreatitis: An Experience From a Tertiary Care Teaching Hospital in Andhra Pradesh

## TL;DR

This study evaluates the effectiveness of BISAP and CTSI scores in predicting outcomes for acute pancreatitis patients at a hospital in Andhra Pradesh.

## Contribution

The study demonstrates the combined utility of BISAP and CTSI scores for improved clinical decision-making in acute pancreatitis management.

## Key findings

- BISAP score ≥3 was significantly associated with mortality (p=0.039) and had high predictive accuracy (AUC=0.934).
- CTSI indicated severe AP in 12% of patients and was strongly linked to mortality and complications (p=0.002).

## Abstract

Introduction

Acute pancreatitis (AP) is a potentially life-threatening inflammatory disorder of the pancreas with a wide spectrum of clinical manifestations. Early identification of disease severity is critical for guiding management and improving outcomes. Prognostic scoring systems such as the Bedside Index for Severity in Acute Pancreatitis (BISAP) and the CT severity index (CTSI) are commonly used to predict disease progression and complications. This study aimed to evaluate the clinical profile of patients with AP and assess the utility of BISAP and CTSI scores in predicting clinical outcomes.

Methods

This cross-sectional study was conducted in the Department of General Medicine from April 2025 to May 2025 (two months). Patients diagnosed with AP were enrolled based on clinical, biochemical, and radiological criteria. Detailed clinical histories, physical examinations, and laboratory investigations were recorded. BISAP scores were calculated at admission, and contrast-enhanced CT scans were performed on day four or five of illness to determine CTSI scores. Patients were monitored throughout their hospital stay, and outcomes were assessed at discharge.

Results

Fifty patients with AP were enrolled. The most common etiology was alcohol consumption (74%). A BISAP score ≥3 was observed in 6% of patients and was significantly associated with mortality (p=0.039). The CTSI indicated severe AP in 12% of patients and was significantly associated with both mortality (p=0.002) and complications (p=0.002). The BISAP score demonstrated excellent predictive ability for mortality [area under the curve (AUC)=0.934], while CTSI provided superior sensitivity and predictive accuracy for complications (AUC=0.658). A moderate positive correlation was observed between BISAP and CTSI (r=0.45, p=0.019).

Conclusions

Both BISAP and CTSI are effective predictors of outcomes in AP. BISAP is a valuable bedside tool for early mortality risk stratification, particularly in resource-limited settings, while CTSI remains indispensable for assessing complications and guiding interventional strategies. The combined use of both scoring systems can enhance clinical decision-making and optimize patient management.