Are BISAP and APACHE II scores still useful to identify high-risk patients in acute pancreatitis? A retrospective multicenter analysis on 450 patients

Early risk stratification in acute pancreatitis is essential to guide clinical management and resource allocation. This study evaluated and compared the performance of the Bedside Index of Severity in Acute Pancreatitis (BISAP) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores in predicting disease severity and in-hospital mortality. We conducted a retrospective multicenter cohort study including 450 consecutive patients admitted with acute pancreatitis between 2016 and 2025. BISAP and APACHE II scores were calculated within the first 24 h of admission. Disease severity was classified according to the revised Atlanta classification. Discriminative ability was assessed using receiver operating characteristic (ROC) curve analysis with area under the curve (AUC) comparison. Multivariate logistic regression was performed to identify independent predictors of severe disease and mortality. The overall in-hospital mortality rate was 9.1%. Both BISAP and APACHE II scores were significantly associated with disease severity and mortality. ROC analysis demonstrated good discriminative performance for both scores, with a trend toward higher accuracy for BISAP (AUC 0.89 vs. 0.82 for mortality; P = 0.08). BISAP showed higher sensitivity and negative predictive value (100%), whereas APACHE II demonstrated lower sensitivity but comparable negative predictive value (97%). On multivariate analysis, BISAP remained a strong independent predictor of mortality (OR 2.10, 95% CI 1.65-2.68, P < 0.001) and severe disease, alongside age, comorbidities, and fever at admission. APACHE II also showed an independent but weaker association. Both BISAP and APACHE II are effective tools for early risk stratification in acute pancreatitis. BISAP offers high sensitivity and excellent negative predictive value, supporting its role as a practical screening tool at admission, while APACHE II may provide complementary value for risk refinement. These findings support an integrated approach combining simple bedside assessment with comprehensive clinical evaluation.