Bedside Index for Severity in Acute Pancreatitis
A simple 5-point score assessed within the first 24 hours of admission that predicts in-hospital mortality in acute pancreatitis. Compares favourably with Ranson and APACHE II for early severity stratification.
| BISAP Score | In-Hospital Mortality | Organ Failure Rate | Management |
|---|---|---|---|
| 0 | < 1% | < 2% | General ward — monitor; early oral feeding |
| 1 | ~1% | ~5% | General ward with close monitoring |
| 2 | ~2–7% | ~10% | Consider step-down/high-dependency unit |
| 3 | ~5–20% | ~20% | HDU/ICU; early aggressive fluid resuscitation; CT at 72 h |
| 4 | ~22% | ~35% | ICU; monitor for organ failure; consider early ERCP if gallstone aetiology |
| 5 | ~22–27% | >50% | ICU; multidisciplinary care; early identification of necrosis |
All five BISAP criteria can be assessed at the bedside within 24 hours of admission, without requiring CT imaging. This makes it particularly useful for early triage in emergency departments and general surgical wards.
Derived by Wu et al. (2008) from a database of 17,992 acute pancreatitis admissions. The c-statistic for in-hospital mortality was 0.82 vs 0.83 for Ranson (48 h) and 0.74 for APACHE II — demonstrating that BISAP at 24 h performs comparably to more complex scores assessed over a longer period.
Validated in multiple independent cohorts including Indian (Singh et al. 2009, n=212, AUC 0.77) and Chinese populations (Gao et al. 2015, meta-analysis: AUC 0.819 for mortality).