Comparison of Scoring System (Ranson's vs BISAP) for Prediction of Morbidity and Mortality in Patients of Acute Pancreatitis
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Background: Early risk stratification in acute pancreatitis is essential for identifying patients at risk of severe disease, organ failure, intensive care admission, and mortality. Ranson’s criteria are comprehensive but require 48 hours for completion, whereas the Bedside Index of Severity in Acute Pancreatitis (BISAP) is simpler and available within the first 24 hours. Objective: To compare the diagnostic performance of Ranson’s criteria and BISAP score for predicting severe acute pancreatitis, composite morbidity, and in-hospital mortality. Methods: This prospective observational diagnostic and prognostic accuracy study was conducted at the Department of Gastroenterology, Pak Emirates Military Hospital, Rawalpindi, from July 2023 to June 2024. A total of 120 adult patients with acute pancreatitis were enrolled consecutively. BISAP was calculated within 24 hours and Ranson’s criteria at 48 hours. Severe acute pancreatitis was classified according to the Revised Atlanta Classification. Diagnostic accuracy measures, receiver operating characteristic analysis, and morbidity associations were assessed at a cutoff score of ≥3. Results: Severe acute pancreatitis occurred in 40 patients (33.3%), and in-hospital mortality occurred in 10 patients (8.3%). For severity prediction, Ranson’s criteria showed sensitivity of 100.0%, specificity of 81.2%, PPV of 72.7%, NPV of 100.0%, and AUC of 0.942, while BISAP showed sensitivity of 60.0%, specificity of 96.2%, PPV of 88.9%, NPV of 82.8%, and AUC of 0.896. The AUC difference was not statistically significant. For mortality prediction, Ranson’s criteria were more sensitive, while BISAP was more specific. Conclusion: Ranson’s criteria provided superior sensitivity and rule-out value after 48 hours, whereas BISAP offered superior specificity and earlier rule-in value within 24 hours. Sequential use of BISAP followed by Ranson’s criteria may offer a pragmatic approach to risk stratification, although further multicenter validation is required
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