Prognostic Value of BISAP Score Combined with 48-Hour C-Reactive Protein for Early Prediction of Severe Acute Pancreatitis: A Retrospective Single-Center Study

Background: Early identification of severe acute pancreatitis (SAP) remains essential for reducing morbidity and mortality. The Bedside Index for Severity in Acute Pancreatitis (BISAP) score is a simple and validated prognostic tool, whereas C-reactive protein (CRP) measured at 48 hours is an accessible inflammatory biomarker associated with disease severity. This study aimed to evaluate the prognostic performance of BISAP combined with 48-hour CRP for predicting severe acute pancreatitis.
Methods: We conducted a retrospective single-center study including adult patients hospitalized for acute pancreatitis between January 2022 and January 2025. Acute pancreatitis was diagnosed according to the revised Atlanta 2012 criteria. BISAP score was calculated within the first 24 hours of admission, and CRP levels were measured at 48 hours. Severe acute pancreatitis was defined according to the revised Atlanta classification. Diagnostic performances were assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curve analysis, and multivariate logistic regression.
Results: A total of 165 patients were included, of whom 45 (27%) developed severe acute pancreatitis. BISAP ≥3 demonstrated good prognostic accuracy with a sensitivity of 77%, specificity of 85%, PPV of 68%, NPV of 91%, and AUC of 0.85. CRP ≥150 mg/L showed a sensitivity of 77%, specificity of 71%, PPV of 50%, NPV of 89%, and AUC of 0.79. The combined BISAP–CRP model achieved the best discriminative performance with an AUC of 0.89. The strategy “BISAP ≥3 OR CRP ≥150 mg/L” improved sensitivity and NPV, whereas “BISAP ≥3 AND CRP ≥150 mg/L” improved specificity and PPV.
Conclusion: The BISAP score is a simple and reliable predictor of severe acute pancreatitis. Combining BISAP with 48-hour CRP significantly improves prognostic performance and may represent a clinically useful strategy for early risk stratification.