Comparison of the effects of BISAP score, SII, and SIRI indices on the prognosis in patients admitted to the emergency department with abdominal pain and diagnosed with acute pancreatitis

Background-aim: In patients diagnosed with Acute Pancreatitis (AP), various scoring systems are used to determine the severity and prognosis of the disease. However, despite these scoring systems and studies, predicting the severity and prognosis remains quite challenging. The Systemic Immune-Inflammation Index (SII) and the Systemic Inflammation Response Index (SIRI) are practical and cost-effective tools supported by various studies in the literature. In this study, we compared the BISAP score with SII and SIRI in patients admitted to the emergency department with abdominal pain and subsequently diagnosed with AP, in order to evaluate their clinical course. Material-method: Our study is a retrospective analysis, including 301 patients who presented to the Emergency Department of Manisa Celal Bayar University Hospital with abdominal pain and were diagnosed with Acute Pancreatitis (AP) between January 1, 2022, and December 31, 2024, meeting the study criteria. All patient parameters were reviewed and recorded using the Hospital Information Management System (HIMS) and patient files. Results: Of the 301 cases included in the study, 52.2% were female (n=157) and 47.8% were male (n=144), with a mean age of 61.9 ± 17.0 years. From an etiological perspective, the majority of patients (92.7%) were diagnosed with biliary pancreatitis, whereas a smaller proportion (7.3%) had non-biliary causes. Among comorbidities, hypertension (39.9%) and diabetes mellitus (22.9%) were identified as the most prevalent conditions. A total of 81.4% of patients (n=245) were discharged following inpatient ward follow-up, 10.6% (n=32) were admitted to the intensive care unit (ICU), and 8.0% (n=24) were discharged directly from the emergency department. The one-month mortality rate in the study group was 5.3% (n=16).No significant difference was observed regarding sex. The presence of diabetes mellitus was found to be associated with mortality. In our study, BISAP, SII, and SIRI values were found to be significantly associated with mortality and intensive care unit (ICU) admission. According to the ROC analysis, the BISAP score (AUC=0.841) demonstrated the highest discriminative power in predicting ICU admission. SII (AUC=0.708) and SIRI (AUC=0.728) also showed statistically significant discriminatory ability and were particularly associated with poor clinical outcomes at higher values. In multivariate analysis, only BISAP remained an independent predictor, whereas SII and SIRI, despite being associated with mortality, did not emerge as independent prognostic factors. Conclusion: BISAP was found to be the most reliable score for predicting mortality and the need for intensive care. Although SII and SIRI were not independent predictors, they were associated with mortality and contributed meaningfully to reflecting clinical outcomes. Due to their low cost and easy accessibility, these indices can be practically applied in the emergency department. In conclusion, while BISAP remains the primary scoring system, the combined use of SII and SIRI may provide additional support to clinicians in predicting patient prognosis at an early stage.