predicting the severity of acute pancreatitis
Last reviewed 07/2021
predicting severe acute pancreatitis
Several scoring systems have been developed to predict the likelihood of developing severe pancreatitis:
- acute physiology and chronic health examination (APACHE) II
- is widely used and can be calculated at any time during a patient’s stay in hospital
- uses 12 criteria to predict the severity of pancreatitis
- cut-off score of more than eight points at admission is considered to be an indication of developing severe disease
- several observational studies have reported that specificity can be increased by raising the threshold to 10 points or more at admission
- has a sensitivity of 95% when used daily for reassessment of patients in the intensive care unit
- has several important limitations – requires multiple parameters, need
for an online calculator
- RANSON score
- modified Glasgow score
- designed to be calculated over 48 hours
- 8 factors are measured
- bedside index of severity in acute pancreatitis (BISAP)
- used during the first 24 hours of admission to hospital
- a point is given for each of the following criteria and a score of than three indicates an increased risk of death
- blood urea nitrogen level > 8.9 mmol/L
- impaired mental status
- systemic inflammatory response syndrome is present
- age > 60 yr
- pleural effusion on radiography
- has been shown to have similar accuracy to the APACHE II for predicting
death
- BALI score
- evaluates only four variables - blood urea nitrogen level, age, lactate dehydrogenase level, and IL-6 level
- measured at admission and can be repeated throughout the first 48 hours of hospitalization
- if score is
- 3 - mortality rate >= 25%
- 4 - mortality rate >= 50%
- CT severity index
- based on CT findings at admission
- assess for the presence of peripancreatic inflammation, phlegmon, and, if present, the amount of pancreatic necrosis
- two scores, CT score and necrosis score are combined to determine severity.
- a score of >= 5 is associated with a statistically significant increase in morbidity and mortality
- has been shown to be superior to Ranson and APACHE II in predicting severity and outcomes in pancreatitis (sensitivity of 87% and specificity of 83%)
A simple system called harmless acute pancreatitis score (HAPS) has been developed more recently. The main aim is to identify the patients who would run a non severe or mild course of acute pancreatitis.
- mild acute pancreatitis can be predicted with 98% accuracy within 30 min of inpatient admission
- even non specialists can run this system and can be used in the community care setting to triage the patients who need early transfer to more specialised centres
- takes into account three parameters
- absence of rebound tenderness or guarding
- normal haematocrit
- normal serum creatinine
An ideal prognostic score should be simple, non-invasive, accurate, quantitative, and the assessment methods should be easily applicable at the time of diagnosis. None of the available scoring systems fulfill this hence cannot be used alone in predicting severity. In 2013, the American College of Gastroenterology guideline suggested that severity estimation should be based on patient-specific factors (radiologic and laboratory) rather than depending on a scoring system. These include:
- patient characteristics
- age >55 years
- obesity (BMI >30 kg/m2)
- altered mental status
- comorbid disease
- presence of SIRS - presence of >2 of the following criteria:
- pulse >90 beats/min
- respirations >20/min or PaCO2 >32 mm Hg
- temperature >38 °C or <36 °C
- WBC count >12,000 or <4,000 cells/mm3 or >10% immature neutrophils (bands)
- laboratory findings
- BUN >20 mg/dl
- rising BUN
- HCT >44%
- rising HCT
- elevated creatinine
- radiology findings
- pleural effusions
- pulmonary infiltrates
- multiple or extensive extrapancreatic collections (3)
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