Glucose-enhanced BISAP score for early prediction of severe acute pancreatitis

This study aimed to identify early predictors of severe acute pancreatitis (SAP). Additionally, we examined whether admission laboratory parameters improve the prognostic performance of established severity scoring systems in patients presenting to the emergency department. A prospective observational cohort study was conducted in the ED of a tertiary care hospital between 15 September 2023 and 15 September 2024. A total of 208 adult patients diagnosed with AP were enrolled. Demographic characteristics, clinical findings, laboratory parameters, imaging results, complications, and outcomes were recorded. Variables associated with SAP were examined using univariate analysis followed by backward stepwise multivariate logistic regression. Predictive accuracy was assessed using receiver operating characteristic (ROC) analysis. Of the 208 patients, 52.4% were female, and the median age was 57 years (IQR: 41-68.8). SAP occurred in 11.1% of cases. In multivariate analysis, both the BISAP score (OR: 4.398; 95% CI: 2.205-8.775; p < 0.001) and admission glucose level (OR: 1.009; 95% CI: 1.003-1.016; p = 0.007) were independent predictors of SAP. A combined model incorporating BISAP and glucose demonstrated very good discriminative performance (AUC: 0.889; 95% CI: 0.850-0.972), with 87% sensitivity and 70.3% specificity. BISAP alone also showed strong predictive ability (AUC: 0.833; 95% CI: 0.727-0.938). A glucose-enhanced BISAP model provides a practical and highly accurate early risk-stratification tool for predicting severe disease among ED patients with AP. Incorporating admission glucose into BISAP may support timelier clinical decision-making and improve early management strategies.