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Open Access 
F u l l  L e n g t h  A r t i c l e  

Comparison of Ranson’s Score, BISAP, and CTSI in Predicting the 

Severity of Acute Pancreatitis 
 

Saad Sarfraz Janjua 1, Fakhar Zaman 2, Tehmina Qamar 3, Fawad Mirza 4, Asaf Alvi 5, Muhammad Hanif 6 

1,2 Postgraduate Resident, BBH Surgical Unit Rawalpindi 
3 Associate Professor, Department of Biochemistry, Rawalpindi Medical University 

4 Senior Registrar, BBH Surgical Unit Rawalpindi 
5 Assistant Professor, BBH Surgical Unit Rawalpindi 

6 Professor, Department of Surgery, BBH Surgical Unit Rawalpindi 

 

A B S T R A C T  

Objective: To use of Ranson’s, BISAP and CTSI scoring system in predicting the severity and outcomes of patients 

with acute pancreatitis. 

Patients and Methods: One hundred and six (106) patients of acute pancreatitis were studied prospectively. Data of 

patient’s baseline demographics, clinical and radiological investigation was collected. BISAP score was calculated by 

obtaining data within 24 hours of admission, while Ranson score was calculated at the time of admission and at 48 hours 

of admission. CTSI was based on findings from CT scan of selected patients. Severity of acute pancreatitis was defined 

in terms of ICU admission, development of associated complications and mortality. 

ResultsOut of 106 patients, 55.7% were females and 44.3% were male patients. Regarding complications of Acute 

Pancreatitis, 9 (8.5%) patients were admitted in ICU, complications occurred in 33 (31.1%) patients while mortality 

occurred in 9 (8.5%) patients. Out of 106 patients 11 patients had Ransons score greater than 3. 04(36.4%) patients 

required ICU admission, 07(63.6%) patients developed complications and mortality of 5(45.5%) patients occurred. 

Patients with Bisap score greater 03, 6 (26%) patients required ICU admission, 17 (74%) developed complications and 

mortality of 8(34.7%) patients occurred. 24 patients underwent CECT abdomen and 4 patients had modified CTSI score 

of 8 to 10 (severe AP) out of which 4(100%) patients required ICU admission, 4(100%) patients developed complications 

and mortality occurred in 4(100%) patients. 

Conclusion: BISAP score is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can 

be a crucial aid in determining the group of patients that have a high chance of need for intensive care during the course 

of their illness and therefore need early resuscitation; especially in resource-limited developing countries. 

Key words: Acute pancreatitis, BISAP score, Modified CTSI score, Ranson score 

Author`s Contribution 
1-3

 Conception, synthesis, planning of 
research and manuscript writing 
Interpretation and discussion  
4-6 

Data analysis, interpretation and 
manuscript writing, 

 
Active participation in 

data collection. 

Address of Correspondence 
Saad Sarfraz Janjua 
Email: saadicarnot@hotmail.com 

Article info. 
Received:  October 10, 2010 
Accepted: September 20, 2018 

Cite this article. Janjua SS, Zaman F, Qamar T, Mirza F, Alvi A, Hanif A. Compaison of 
Ranson’s Score, BISAP and CTSI in Predicting the Severity of Acute Pancreatitis. JIMDC.2018; 
7(4):255-259 
 

Funding Source: Nil 
Conflict of Interest: Nil 

I n t r o d u c t i o n  
 

Acute pancreatitis (AP) is inflammation of pancreas that 

sometimes may involve adjacent or remote body organs 

in severe cases.1 Only 10 to 20% patients have mild 

inflammation and have good prognosis. But in severe 

O R I G I N A L  A R T I C L E  

mailto:saadicarnot@hotmail.com


 

                           256 J I M D C   2 0 1 7  256 

cases, patients present with pancreatic necrosis or with 

distant organ failure requiring intense medical 

management or surgical intervention with mortality risk of 

40%. overall mortality risk is 5 to 10%.2 Therefore, early 

detection and determination of severity of AP is very 

crucial for optimal management. Because sometimes mild 

cases may progress to severe cases resulting in high 

mortality rates. Unfortunately, no laboratory or diagnostic 

test is available for this and different risk scoring systems 

have been developed to determine the AP.3    

Out of various scoring systems, BISAP (Bedside index of 

severity in acute pancreatitis), Ranson’s score and CTSI 

(computed tomography severity index) scoring system are 

commonly used for determining AP severity. Ranson’s 

score include 11 variables, presence of 3 or >3 indicates 

severe AP.4 BISAP score have 5 variables to determine 

severe AP (presence of age >60 years, pleural effusion, 

BUN >25mg/dL, presence of SIRS and impaired mental 

health).5,6 While modified CTSI is linked only with grading 

of pancreatic necrosis and extent of pancreatic necrosis.7 

All of these scors have potential risk and benefits and 

have been used in routine practice. In present study, we 

aimed to determine the accuracy of BISAP, Ranson’s and 

CTSI scoring system in determining the severity of AP. 

P a t i e n t s  a n d  M e t h o d s  

One hundred and six (106) patients of acute pancreatitis 

of age 10 years to 90 years and any gender were studied 

prospectively. Data of patient’s baseline demographics, 

clinical and radiological investigation was collected. 

Approval of study was taken before starting data 

collection. Mixed clinical and laboratory investigations 

data was used to confirm the diagnosis of AP (i.e. 

abdominal pain, increased serum amylase/lipase levels 

more than three folds, findings of AP on abdominal 

ultrasonography). After diagnosis of AP, these patients 

were informed about study purpose and protocols in the 

emergency department and informed consent was signed 

from them. Patients with chronic pancreatitis were not 

included in the study. Venous and arterial blood samples 

were taken and sent to the lab for measurements of 

patients’ blood gases, liver and renal function parameters 

and complete blood investigations. CT scan was 

performed in only selected patients and calculation of 

modified CTSI score was done on the basis of findings on 

CT scan. BISAP score was calculated by obtaining data 

within 24 hours of admission, while Ransons score was 

calculated at the time of admission and after 48 hours of 

admission. Severity of AP was defined in terms of ICU 

admission, development of associated complications and 

mortality. Severity was noted at the time of 

discharge/death of patients. Initial treatment of AP 

patients was resuscitation using fluids. Inotropes were 

given if needed. Urinary catheter and IV line was passed 

in all patients. Urine output was noted on hourly basis. IV 

line was used for fluid resuscitation. Prophylactic broad-

spectrum antibiotics were given. Patients of severe AP 

who did not improved with medical therapy necrosectomy 

and open drainage was done in these cases. 

Cholecystectomy was done either in same admission or in 

follow-up period. For data analysis, we used SPSS v23 

software. Chi-square test was used to compare 

complications and mortality on the basis of severity of 

scores. P-value <0.05 was taken as significant difference.  

 

Table 1. Baseline variables of Patients (n=106) 

Age of patients n(%) 

10-20 6 (5.7) 

21-30 24 (22.6) 

31-40 20 (18.9) 

41-50 22 (20.8) 

51-60 12 (11.3) 

61-70 16 (15.1) 

71-80 5 (4.7) 

81-90 1 (0.9) 

Gender 

Male 47 (44.3) 

Female 59 (55.7) 

Type of Admission 

New 88 (83.0) 

Follow-up 18 (17.0) 

Cause of AP 

Gallstones 73 (68.9) 

Idiopathic 20 (18.9) 

Hypertriglyceridemia 6 (5.7) 

Alcohol Induced 4 (3.8) 

Post ERCP 1 (0.9) 

Drug Induced 1 (0.9) 

Corrosive Intake 1 (0.9) 



 

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Table 2. Association of Scoring Systems in Predicting Complications and Mortality in AP Patients (n=106) 

Scoring System ICU Admission Complications Mortality P-value 

Yes No Yes  No Yes No 

Ranson’s Score 

<3 5 (5.3) 90 (94.7) 26 (27.4) 69 (72.6) 4 (4.2) 91 (95.8) 0.006, 0.02, 
<0.0001 >3 4 (36.4) 7 (63.6) 7 (63.6) 4 (36.4) 5 (45.5) 6 (54.5) 

BISAP Score 

<3 3 (3.6) 80 (96.3) 16 (19.2)  67 (80.7) 0 (0) 83 (100) 0.47, 0.001, 0.001 

>3 6 (26) 17 (74) 17 (73.9) 6 (26.08) 8(34.7) 15 (65.2) 

Modified CTSI Findings 

0 -2 mild 0 (0.0) 10 (100) 7(70) 3(30) 0 (0) 10 (100) <0.001, 
<0.0001, 
<0.001 

4-6 moderate 5 (50.0) 5 (50.0) 10(100.0) 0 (0.0) 2(20.0) 8 (80.0) 

8-10 severe 4 (100) 0 (0) 4(100) 0 (0.0) 4 (100) 0 (0) 

 

R e s u l t s  

A total number of 106 patients of AP were studied. Most 

of the patients 24 (22.6%) were in age group 21-30 years, 

22 (20.8%) were in age group 41-50 years, 20 (18.9%) 

were in age group 31-40 years’ age group. There were 

55.7% females and 44.3% male patients. There were 88 

(83.0%) new admissions and remaining 18 (17.0%) were 

follow-up. Most common cause of AP was gallstones in 

73 (68.9%), idiopathic in 20 (18.9%) patients and 

hypertriglyceridemia in 6 (5.7%) patients (Table 1). 

Regarding complications of AP, 9 (8.5%) patients were 

admitted in ICU, complications occurred in 33 (31.1%) 

patients while mortality occurred in 9 (8.5%) patients. 

Most common complication in AP patients was 

pseudocyst occurred in 7 (6.6%) patients, ascites in 6 

(5.7%), shock in 3 (2.8%) patients, while pleural effusion 

and acute renal failure occurred in 1 (0.9%), 1 (0.9%) 

cases only respectively. 11(10.4%) patients had multiple 

complications. Regarding reliability of scoring systems in 

predicting severity and mortality due of AP. Out of 106 

patients, 11 patients had Ransons score greater than 3, 

signifying severe pancreatitis. Out of 11 patients 

04(36.4%) patients required ICU admission, 7(63.6%) 

patients developed complications due to pancreatitis and 

mortality of 5 (45.5%) patients occurred. Whereas 95 

patients had Ransons score less than 03 and mortality of 

4(4.2%) patients occurred in this group. 

Out of all patients, 23 patients had BISAP score greater 

than or equal to three, 6 (26%) patients required ICU 

admission, 17 (74%) developed complications and  

 

 

mortality of 8(34.7%) patients occurred (Table 2). 

Mortality of patients with individual BISAP score of 3 was 

7.6 %, with BISAP score 4 mortality rate was 50% and 

with BISAP scores 5 and 6, mortality was 100 % (TABLE 

3). CECT with pancreatic protocol was done for 24 

patients. On the basis of findings on CT scan, modified 

CT severity index score was calculated. In patients having 

modified CTSI score equal to zero to two (mild AP), no 

patient required ICU admission, 7(70%) patients 

developed complications and no mortality occurred. 

(Table 2). In patients having modified CTSI score of 4 to 6 

(moderate AP), 5(50%) patients required ICU admission, 

10(100%) patients developed complications and mortality 

of 2(20%) patient occurred. In patients having modified 

CTSI score of 8 to 10 (severe acute pancreatitis) 4(100%) 

patients required ICU admission, 4(100%) patients 

developed complications and mortality of 4(100%) 

patients occurred (Table 2). 

Table 3. Mortality with individual BISAP score 

BISAP 

score 

Mortality 

Yes (%) No (%) Total 

0 0 35 (100) 35 

1 0 35 (100) 35 

2 0 13 (100) 13 

3 1(7.6) 12 (92.3) 13 

4 3(50) 3 (50) 6 

5 3(100) 0 3 

6 2 (100) 0 2 

Total 09 97 106 

 



 

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Table 4. Mortality with individual RANSONS score. 

RANSONS 

Score 

Mortality 

Yes (%) No (%) Total 

0.00 0 (0) 20 (100) 20 

1.00 0 (0) 23 (100) 23 

2.00 0 (0) 17 (100) 17 

3.00 1 (7) 13 (93.0) 14 

4.00 1 (6) 14 (94.0) 15 

5.00 3 (33) 6 (67.0) 9 

6.00 2 (33) 4 (67.0) 6 

7.00 2 (100) 0 (0.0) 2 

Total 9 (8.4) 96 (91.6) 106 
 

 

D i s c u s s i o n  

Acute pancreatitis is one of the common presentations in 

medical emergency departments. Due to high morbidity 

and mortality, early diagnosis and prediction of severity is 

very essential for optimal management of patients. In 

present study, we determined the accuracy of the 

Ranson’s, BISAP and modified CTSI scoring system in 

predicting the severity and associated mortality in AP 

patients. Most of our patients (> 60%) were between 21-

50 years old and majority were females (55.7%). A study 

conducted by Kumar et al. reported that mean age in their 

study was 48.42 years, and female population in their 

study was 66.0% (8). While in a study by Yadav et al. 

mean age was 38.94+14.59 years, and female population 

was 70.6%.9 Regarding etiology, the most common cause 

was gallstones, diagnosed in 68.9% patients. Kumar et al. 

reported gallstones in 74.0% patients of AP followed by 

alcohol abuse in 18.0% patients.8 Khanna and Yadav et 

al. also reported gallstones as commonest etiology in AP 

patients.9,10I n present study, 8.5% patients were admitted 

in ICU, complications occurred in 31.1% patients and 

mortality occurred 8.5% patients. Yadav et al. reported 

mortality in 10.1% of the AP patients. While studies by 

Bollen et al. and Carnovale et al. reported mortality in only 

3.5% and 4.8% patients respectively.11,12  

Regarding accuracy of different scoring systems, modified 

CTSI was the most accurate among all three scores. In 

patients having CTSI score >2 (>30 % necrosis), ICU 

admissions occurred in 85.7% patients, complications in 

100% patients and mortality in 57.1% patients. While 

Ranson score and BISAP score were important tool in risk 

stratification in patients with acute pancreatitis. In 

government setup, like ours due to very high patient load 

and limited facilities Ransons score has a great role in 

predicting outcomes because it is easy to calculate and 

has very small financial burden on system. Drawback of 

Ransons score is that it takes 48 hours to calculate it. The 

advantage of BISAP score is the relative ease with which 

data can be acquired and can be calculated within 24 

hours of presentation. Patients with a BISAP score of 

equal to or greater than 4 have high mortality.  

Kumar et al. conducted a study on comparison of 

APACHE II, BISAP, Ranson’s score and modified CTSI 

score in predicting AP severity and mortality also reported 

that modified CTSI has highest accuracy in predicting ICU 

admissions, complications and mortality in these patients. 

These authors found almost similar accuracy of BISAP 

and Ranson score.8 While a study by Yang et al. 

comparing Ranson, BISAP, APACHE II, and MCTSI score 

in hyperlipidemia induced AP patients, reported that 

MCTSI is outstanding in predicting complications, but is 

not good in predicting severity and mortality in these 

patients.13 Studies by Mortele et al. and Banday et al. also 

reported CTSI as a simpler and best tool for predicting 

hospital stay, infections risk, organ failure risk and 

mortality in AP patients.14,15 

C o n c l u s i o n  

Modified CTSI is most accurate score in predicting ICU 

admissions, complications and mortality in AP patients, 

however the BISAP score represents a simple way of 

identifying patients at greater risk of dying and developing 

complications within 24 hours of presentation. Also BISAP 

score should be considered for risk stratification because 

as the BISAP score increases, its accuracy in predicting 

Table 5. Mortality with overall CTSI Score 

CTSI score 

Mortality 

Total Yes (%) No (%) 

00 0 (0) 4 (100) 4 

2.00 0 (0) 6 (100) 6 

4.00 1 (16) 5 (84.0) 6 

6.00 1 (25) 3 (75.0) 4 

8.00 4 (100) 0 (0.0) 4 

Total 6 (25.0) 18 (75.0) 24 



 

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mortality increases. RANSONS score was least accurate 

among BISAP score and CTSI scoring system for 

predicting outcomes in AP patients. 

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