Bedside Index for Severity in Acute Pancreatitis (BISAP)

...Start of the Bedside Index for Severity in Acute Pancreatitis (BISAP)...

The aim of this study was to evaluate the diagnostic performance of Bedside Index for Severity in Acute Pancreatitis (BISAP) score for predicting severe acute pancreatitis (SAP) in the early phase. The PubMed, Cochrane library and EMBASE databases were searched until May 2014. The strict selection criteria and exclusion criteria were determined, and we applied hierarchic summary receiver operating characteristic ( HSROC) model and bivariate random effects models to assess the diagnosibility of the BISAP score for predicting SAP. We obtained pooled summary statistics for sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and calculated the area under the HSROC curve (AUC). The 95% confidence intervals (CI) for each diagnostic test measure were also calculated.

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The AUC of the HSROC was 0.77 (95%CI: 0.73-0.80) (Fig. The index of heterogeneity was 95% (95% CI, 91%-99%). There was a negative correlation between the logits of sensitivity and specificity (Spearman correlation coefficient, 20.09), indicating the present of an important effect of the diagnostic threshold (cutoff level) on the performance of BISAP score. The following cutoffs were selected for subgroups analysis (Table 4). Analysis of studies that set the BISAP cutoff point at 2, the pooled sensitivity, specificity, PLR, NLR, and DOR were 67.30% (95%CI: 60.53%-73.42%), 78.28% (95%CI: 68.86%-85.46%), 3.10 (95%CI: 2.12-4.52), 0.42 (95%CI: 0.34-0.51) and 7.42 (95%CI: 4.39-12.54), respectively.

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Third, there is a risk for publication bias in which positive results or results with ‘expected’ findings are more likely to be published. We made every possible effort to minimize this type of bias by contacting investigators in the field of BISAP. If editors were more likely to publish manuscripts showing the ‘expected’ results of a good diagnostic performance for BISAP, then our results may be overestimating the real diagnostic performance of BISAP. In conclusion, we confirmed that BISAP score is an accurate means to predict SAP in the early phase. Due to simplicity and easily obtained parameters, BISAP score should gain broad acceptance in routine use not by replacing clinical assessment, but rather by complementing and objectifying it.

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