Early Changes in Blood Urea Nitrogen (BUN) Can Predict Mortality in Acute Pancreatitis: Comparative Study between BISAP Score, APACHE-II, and Other Laboratory Markers-A Prospective Observational Study

Elizabeth Pando, Piero Alberti, Rodrigo Mata, María José Gomez, Laura Vidal, Arturo Cirera, Cristina Dopazo, Laia Blanco, Concepción Gomez, Mireia Caralt, Joaquim Balsells, Ramón Charco, Elizabeth Pando, Piero Alberti, Rodrigo Mata, María José Gomez, Laura Vidal, Arturo Cirera, Cristina Dopazo, Laia Blanco, Concepción Gomez, Mireia Caralt, Joaquim Balsells, Ramón Charco

Abstract

Background: Changes in BUN have been proposed as a risk factor for complications in acute pancreatitis (AP). Our study aimed to compare changes in BUN versus the Bedside Index for Severity in Acute Pancreatitis (BISAP) score and the Acute Physiology and Chronic Health Evaluation-II score (APACHE-II), as well as other laboratory tests such as haematocrit and its variations over 24 h and C-reactive protein, in order to determine the most accurate test for predicting mortality and severity outcomes in AP.

Methods: Clinical data of 410 AP patients, prospectively enrolled for study at our institution, were analyzed. We define AP according to Atlanta classification (AC) 2012. The laboratory test's predictive accuracy was measured using area-under-the-curve receiver-operating characteristics (AUC) analysis and sensitivity and specificity tests.

Results: Rise in BUN was the only score related to mortality on the multivariate analysis (p=0.000, OR: 12.7; CI 95%: 4.2-16.6). On the comparative analysis of AUC, the rise in BUN was an accurate test in predicting mortality (AUC: 0.842) and persisting multiorgan failure (AUC: 0.828), similar to the BISAP score (AUC: 0.836 and 0.850) and APACHE-II (AUC: 0.756 and 0.741). The BISAP score outperformed both APACHE-II and rise in BUN at 24 hours in predicting severe AP (AUC: 0.873 vs. 0.761 and 0.756, respectively).

Conclusion: Rise in BUN at 24 hours is a quick and reliable test in predicting mortality and persisting multiorgan failure in AP patients.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2021 Elizabeth Pando et al.

Figures

Figure 1
Figure 1
Comparison of ROC curves for mortality.

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