Comparative Evaluation of BISAP, RANSON, and APACHE-II Prognostic Scores in Acute Pancreatitis during Pregnancy: A Retrospective Study of 30 Cases

Abstract

Background: Acute pancreatitis during pregnancy is a rare but potentially life-threatening condition associated with significant maternal and fetal morbidity and mortality. Early prognostic assessment is crucial for optimal management, yet the validity of established prognostic scores in pregnant women remains incompletely characterized. Objective: To evaluate and compare the diagnostic performance of the BISAP, RANSON, and APACHE-II prognostic scores in predicting severity, morbidity, mortality, short- and long-term complications, and length of hospital stay in acute pancreatitis during pregnancy. Methods: This was a retrospective, single-center study conducted over a 2-year period (January 2023 to December 2024) that included 30 consecutive pregnant women with acute pancreatitis. All patients underwent systematic abdominal MRI with Balthazar classification. Prognostic scores were calculated within 48 hours of admission. The primary endpoint was the prediction of severity according to the revised Atlanta classification. Secondary endpoints included the prediction of organ failure, local complications, infections, length of stay, and fetal complications. Statistical analysis included ROC curve analysis with calculation of the area under the curve (AUC), sensitivity, specificity, and predictive values. Results: The incidence of acute pancreatitis was 3.5 per 1,000 pregnancies. The mean maternal age was 28.6 ± 4.6 years. A biliary etiology was identified in 90% of cases. According to the Atlanta classification, 33.3% of patients had severe pancreatitis. The areas under the ROC curves were as follows: APACHE-II, 0.990; BISAP, 0.963; and RANSON, 0.945. Optimal thresholds were a BISAP score ≥ 2, a RANSON score ≥ 4, and an APACHE-II score ≥ 9. The Balthazar classification showed a strong correlation with clinical severity (r = 0.89, p < 0.001). Short-term complications occurred in 43.3% of patients (organ failure, 33.3%; local complications, 23.3%; infections, 16.7%). Long-term complications affected 26.7% of patients (post-pancreatitis diabetes, 13.3%; recurrences, 10%). The mean hospital stay was 16.5 ± 3.8 days for severe cases versus 7.8 ± 2.1 days for mild cases (p < 0.001). Four intrauterine fetal deaths (13.3%) occurred, all in severe cases. The BISAP score was the only score to show a statistically significant association with fetal complications (p = 0.03). Conclusions: All three prognostic scores demonstrated good diagnostic performance in predicting the severity of acute pancreatitis during pregnancy. The BISAP score, with its good discriminative ability, simplicity of calculation, and potential association with fetal complications, emerges as a valuable tool for prognostic assessment in obstetric practice. Systematic MRI with Balthazar classification enhances prognostic stratification. These findings support early risk stratification to optimize maternal-fetal outcomes.