P1065 - Validation of a Modified Bedside Index for Severity in Acute Pancreatitis (BISAP) Score for Classification of Severity of Acute Pancreatitis in the National Inpatient Sample Database

Pedro Palacios, MD¹, Miguel Salazar, MD², Paul T. Kroner, MD, MSc¹, Frank J. Lukens, MD¹, Roberto Simons-Linares, MD, MSc^2
1Mayo Clinic, Jacksonville, FL; ²Cleveland Clinic Foundation, Cleveland, OH

Introduction: The Bedside Index for Severity in Acute Pancreatitis (BISAP) score has been validated in multiple population studies as a useful tool for classification of acute pancreatitis (AP). There is no such system for the Healthcare Costs and Utilization Project databases to classify the severity of AP.

Methods: The National Inpatient Sample (NIS) database for the years 2016 and 2017 was queried for all primary adult discharge diagnosis of AP. A modified BISAP (mBISAP) score system was created utilizing ICD-10CM codes for pleural effusion, encephalopathy, acute kidney injury, systemic inflammatory response and patients age ≥60. Each one was assigned a 1-point score according to the already validated BISAP score. A multivariate regression analysis was built to test for mortality including patient and hospital confounders.

Results: A total of 295,525 and 291,835 primary discharges for AAP were identified in 2016 and 2017 respectively. 62% of patients had a mBISAP score of 0 (n=483,104) and 0.01% (n=30) of patients had a mBISAP score of 5 in 2016 and 61.3% (n=178,894) had a mBISAP score of 0 and 0.01% (n=29) a mBISAP score of 5. The pooled mortality rate was: 0.06%,0.4%,2.9%,12.8%,33.3% and 15.7% (P< 0.01) respectively for scores 0 to 5. Those with a mBISAP score of 0 compared to those with a score of 5 were more likely to be younger females and to have private insurance as primary payer. They were less likely to have a Charlson Comorbidity Index score of ≥3, to be from the South region of the country and to be admitted at urban teaching hospitals. Multivariate regression analysis for mortality showed increasing odds of mortality with each one-point increment in the mBISAP score for the year 2016: score of 1 (adjusted odds ratio [aOR] 6.80; 95% confidence interval [CI] 4.01-11.53), score of 2 (aOR 38.04; 95% CI 21.86- 66.20), score of 3 (aOR 175.50; 95%CI 99.73-308.81), score of 4 (aOR 589.09; 95% CI 310.22-1118.65), score of 5 (aOR 173.38; 95% CI 20.70-1452.30) for 2016. For the year 2017: score of 1 (aOR 8.43; 95% CI 4.82-14.73), score of 2 (aOR 44.77; 95% CI 25.01-80.16), score of 3 (aOR 234.44; 95%CI 129.94-422.95), score of 4 (aOR 674.22; 95% CI 347.64-1311.47), score of 5 (aOR 210.13; 95% CI23.29-1895.62).

Discussion: Mortality rates for mBISAP correlate with prior studies and the results demonstrate higher odds of mortality with increasing one-point scores. This is the first study to construct and validate a score to classify AP in nationally representative weighted databases.


Disclosures:


Pedro Palacios, MD¹, Miguel Salazar, MD², Paul T. Kroner, MD, MSc¹, Frank J. Lukens, MD¹, Roberto Simons-Linares, MD, MSc². P1065 - Validation of a Modified Bedside Index for Severity in Acute Pancreatitis (BISAP) Score for Classification of Severity of Acute Pancreatitis in the National Inpatient Sample Database, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.