• Filipe Borges Serviço de Cirurgia, Hospital Garcia de Orta; Almada – Portugal; Faculdade de Medicina da Universidade de Lisboa – Portugal
  • Joana Miranda Faculdade de Medicina da Universidade de Lisboa – Portugal
  • Sofia Silva Faculdade de Medicina da Universidade de Lisboa – Portugal
  • Nuno Carvalho Serviço de Cirurgia, Hospital Garcia de Orta; Almada – Portugal; Faculdade de Medicina da Universidade de Lisboa – Portugal
  • Paulo Matos Costa Serviço de Cirurgia, Hospital Garcia de Orta; Almada – Portugal; Faculdade de Medicina da Universidade de Lisboa – Portugal


Backgrond. Early risk stratification is crucial in Acute Pancreatitis (AP). The BedSide Index for Severity in Acute Pancreatitis (BISAP) allows risk stratification at the time of hospital admission through a five-variable analysis. Several inflammatory markers have shown prognostic value in AP. Amongst them the Neutrophil to Lymphocyte Ratio has the best predictive accuracy. The Harmless Acute Pancreatitis Score (HAPS) is used to predict mild AP. Our objective was to compare BISAP, NLR and HAPS as predictors of severity in acute pancreatitis.

Material and Methods. A six-year (January 2014 – December 2019) retrospective analysis of a prospective database of all the patients admitted with the diagnosis of AP. Included variables: age, sex, BISAP score, NLR, HAPS score, length of stay, severity and mortality. Severity was defined according to 2012 revision of Atlanta classification. Accuracy of prediction was measured by the area under the receiver operating characteristic curve (AUC). Positive Predictive Value (PPV), Negative Predictive Value (NPV), Sensitivity and Specificity were also calculated.

Results. Total of 284 cases; 121 male and 163 female; median age was 71 years [21 – 95]. 216 patients presented mild AP, 34 moderate and 34 severe AP; overall mortality was 4.2%. The BISAP AUC for prediction of severity was 0,86 [0,796 – 0,936]. Sensivity was 44.1% and specificity was 93.2%. PPV was 68.2% and NPV was 92.8%. The NLR AUC was 0,7 [0,607 – 0,798]. Sensivity was 78.8% and specificity was 51.8%. PPV was 78.8% and NPV was 94.8%. Finally, HAPS AUC for prediction of mild AP was 0,706 [0,623 – 0,790]. Sensitivity was 60.6% and specificity was 72.1%. PPV was 87.3% and NPV was 36.6%.

Conclusion. BISAP, NLR and HAPS are valuable tools for an early risk stratification and prognosis evaluation in AP. The best calculated accuracy for the prediction of severity was for BISAP. 


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1. Gao W, Yang HX, Ma CE, et al. “The Value of BISAP Score for Predicting Mortality and Severity in Acute Pancreatitis: A Systematic Review and Meta-Analysis”. PLoS ONE. 2015; 10(6): E0130412. Doi: 10.1371/journal.pone.0130412
2. Cho YS, Kim HK, Jang EC, et al. “Usefulness of the Bedside Index for Severity in Acute Pancreatitis in the Early Prediction of Severity and Mortality in Acute Pancreatitis”. Pancreas. 2013; 42: 483 – 487.
3. Banks PA, Bollen TL, Dervenis C, et al (Group APCW). “Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus.” Gut. 2013; 62 (1):102- 111. doi: 10.1136/gutjnl-2012-302779 

4. Hagjer S, Kumar N. “Evaluation of the BISAP scoring system in prognostication of acute pancreatitis – A prospective observational study”. International Journal of Surgery . 2018. doi: 10.1016/j.ijsu.2018.04.026.
5. Wu B, Johannes RS, Sun X, et al. "The early prediction of mortality in acute pancreatitis: a large population-based 
study." Gut. 2008; 57: 1698-1703. 
 doi: 10.1136/gut.2008.152702
6. Park HS, In SG, Yoon HJ, et al. “Predictive values of neutrophil-lymphocyte ratio as an early indicator for severe acute pancreatitis in the emergency department patients”. J Lab Physicians. 2019 Jul-Sep; 11(3): 259–264. doi: 10.4103/JLP.JLP_82_19: 10.4103/JLP.JLP_82_19
7. Liu G, Tao J, Zhu Z, et al. “The early prognostic value of inflammatory markers in patients with acute pancreatitis”. Clinics and Research in Hepatology and Gastroenterology. 2019; 43: 330—337. doi: 10.1016/j.clinre.2018.11.002
8. Li Y, Zhao Y, Feng L, et al. “Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study”. BMJ Open. 2017; 7:e013206. DOI 10.1136/bmjopen-2016-013206
9. Lankisch PG, Weber-Dany B, Hebel K, et al. “The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratification of nonsevere disease”. Clin Gastroenterol Hepatol, 2009;7:702–5.
10. Oskarsson V, Mehrabi M, Orsini N, et al. “Validation of the Harmless Acute Pancreatitis Score in predicting nonsevere course of acute pancreatitis”. Pancreatology. 2011; 11:464–468. doi: 10.1159/000331502
11. Warndorf M, Kurtzman J, Bartel M, et al. “Early fluid resuscitation reduces morbidity among patients with acute pancreatitis”. Clinic Gastr Hep. 2011; 9: 705 – 709.
12. Gardner TB, Vege S, Chari S, et al. “Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality”. Pancreatology. 2009; 9: 770 – 776
13. Leppaniemi A, Tolonen M, Tarasconi, A, et al. “2019 WSES guidelines for the management of severe acute pancreatitis”. 2019; 14:27
14. Ranson JH, Rifkind KM, Roses DF, et al. “Objective early identification of severe acute pancreatitis”. Am J Gastroenterl.l 1974;61:443–451.
15. Larvin M, McMahon MJ. “APACHE-II score for assessment and monitoring of acute pancreatitis”. Lancet. 1989;334:201–205.
16. Kuo DC, Rider AC, Estrada P, et al. “Acute pancreatitis: what’s the score?”. The Journal of Emergency Medicine. 2015. doi: 10.1016/j.jemermed.2015.02.018
17. Zhou H, Mei X, He X, et al. “ Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase – a retrospective study”. Medicine. 2019; 98:16(e15275). doi: 10.1097/MD.0000000000015275
18. Gray R, Cgliani J, Amodu LI, et al. “Maximizing the use of scoring systems in the prediction of outcomes in acute pancreatitis”. Digestion. 2018. doi: 10.1159/000490887
19. Vasudevan S, Goswami P, Sonika U, et al. “Comparison of various scoring systems and biochemical markers in predicting the outcome in acute pancreatitis”. Pancreas. 2018; 47: 1 – 7. doi: 10.1097/MPA.0000000000000957
20. Yang YX, Li L. “Evaluating the ability of the Bedside Index for severity of Acute Pancreatitis to predict severe acute pancreatitis: a meta-analysis”. Med Princ Pract. 2015. doi: 10.1159/000441003
21. Park J, Jeon TJ, Ha TH, et al. “Bedside index for severity in acute pancreatitis: comparison with other scoring systems in predicting severity and organ failure”. Hepatobiliary Pancreat Dis Int. 2013; 12: 645 – 650. doi: 10.1016/S1499-3872(13)60101-0
22. Sternby H, Hartman H, Johansen D, et al. “Predictive capacity of biomarkers for severe acute pancreatitis”. Eur Surg Res. 2016; 56: 154-163. doi: 10.1159/000444141
23. Lee K, Kim HM, Choi JS, et al. “Comparison of predictive systems in severe acute pancreatitis according to the revised Atlanta classification”. Pancreas. 2016; 45: 46 – 50.
24. Yang CJ, Chen J, Phillips ARJ, et al. “Predictors of severe and critical acute pancreatitis: a systematic review”. Dig Liver Dis. 2014. doi: 10.1016/j.dld.2014.01.158
25. Jeon TJ, Park JY. “Clinical significance of the neutrophil-lymphocyte ratio as an aeraly predictive marker for adverse outcomes in patients with acute pancreatitis”. World J Gastroenterol. 2017; 23(21): 3883-3889. doi: 10.3748/wjg.v23.i21.3883
26. Abayli B, Gençdal G, Degirmencioglu S, et al. “Correlation between neutrophil/lymphocyte ratio and Ranson score in acute pancreatitis”. J Clin Lab Anal. 2018; e22437. doi: 10.1002/jcla.22437
27. Kayar Y, Senturk H, Tozlu M, et al. “Prediction of self-limited acute pancreatitis cases at admission to emergency unit”. GE Port J Gastroenterol. 2019; 26:251 – 259. doi: 10.1159/000493762
How to Cite
BORGES, Filipe et al. COMPARISON OF BISAP, NLR AND HAPS IN PREDICTING SEVERITY OF ACUTE PANCREATITIS, ACCORDING TO THE 2012 REVISION OF ATLANTA CLASSIFICATION. Revista Portuguesa de Cirurgia, [S.l.], n. 49, p. 42-47, jan. 2021. ISSN 2183-1165. Available at: <>. Date accessed: 22 june 2024. doi:
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