Comparison of Harmless Acute Pancreatitis Score (HAPS) and Bedside Index of Severity in Acute Pancreatitis (BISAP) Scoring Systems in Predicting Severity and Outcomes in Acute Pancreatitis: A Prospective Study

Introduction Acute pancreatitis (AP) is a common yet severe digestive disorder characterized by sudden inflammation of the pancreas, resulting in substantial morbidity and mortality. Although the underlying causes of AP are multifactorial, gallstones and alcohol abuse remain the most prevalent triggers. The first 24 hours are critical in determining a patient's risk of complications and outcomes. Various scoring systems, including the Bedside Index of Severity in Acute Pancreatitis (BISAP) and the Harmless Acute Pancreatitis Score (HAPS), have been developed to predict disease severity and guide clinical management. This study compares the performance of these two scoring systems in predicting severe cases of AP. Materials and methods A prospective, hospital-based study was conducted over two years at Maharaja Agrasen Hospital, New Delhi, India, enrolling 102 patients diagnosed with AP. Patients' clinical data, including demographic details, laboratory parameters, and imaging findings, were collected, and both BISAP and HAPS scores were calculated. The primary objective was to compare the sensitivity, specificity, and predictive performance of the two scores in forecasting clinical outcomes, including pancreatic necrosis, organ failure, and mortality. Results Among 102 participants, BISAP demonstrated 100% sensitivity and specificity for mortality prediction. However, the cohort exhibited an exceptionally high mortality rate (82.3%) and complication burden (pancreatic necrosis: 85.3%; organ failure: 80.4%), likely reflecting referral bias in this tertiary care population. HAPS showed higher overall accuracy (65.7% vs. 62.7%), suggesting complementary roles in risk stratification. Caution is warranted when generalizing BISAP's performance to lower-risk cohorts. Discussion This study highlights the predictive value of both BISAP and HAPS in assessing the severity of AP. BISAP demonstrated higher specificity, making it useful for identifying severe cases, while HAPS exhibited better sensitivity and overall accuracy, particularly for predicting pancreatic necrosis. These results suggest that both scores are valuable tools for early identification and risk stratification in AP, though their complementary use may provide the most effective clinical guidance. Further research may be needed to incorporate additional biomarkers to improve diagnostic accuracy. Conclusion Both BISAP and HAPS scoring systems serve as useful tools in predicting the severity of AP, with BISAP excelling in specificity and HAPS in sensitivity. Future clinical protocols may benefit from combining these tools to optimize early detection and management of severe AP cases.