Pancreatitis Prognosis

There are several scoring systems used to help predict the severity of an attack of pancreatitis. The Apache II has the advantage of being available at the time of admission as opposed to 48 hours later for the Glasgow criteria and Ranson criteria. However, the Glasgow criteria and Ranson criteria are easier to use.

APACHE II

Ranson criteria

At admission:

1. age in years > 55 years
2. white blood cell count > 16000 /mcL
3. blood glucose > 11 mmol/L (>200 mg/dL)
4. serum AST > 250 IU/L
5. serum LDH > 350 IU/L

After 48 hours:

1. Haematocrit fall > 11.3444%
2. increase in BUN by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
3. hypocalcemia (serum calcium < 2.0 mmol/L (<8.0 mg/dL))
4. hypoxemia (PO2 < 60 mmHg)
5. Base deficit > 4 Meq/L
6. Estimated fluid sequestration > 6 L

The criteria for point assignment is that a certain breakpoint be met at anytime during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to both biliary and alcoholic pancreatitis.

Interpretation

• If the score ≥ 3, severe pancreatitis likely.
• If the score < 3, severe pancreatitis is unlikely

Or

• Score 0 to 2: 2% mortality
• Score 3 to 4: 15% mortality
• Score 5 to 6: 40% mortality
• Score 7 to 8: 100% mortality

Glasgow criteria

Glasgow's criteria: The original system used 9 data elements. This was subsequently modified to 8 data elements, with removal of assessment for transaminase levels (either AST (SGOT) or ALT (SGPT) greater than 100 U/L).

On Admission

1. Age >55 yrs
2. WBC Count >15 x10⁹/L
3. Blood Glucose >200 mg/dL (No Diabetic History)
4. Serum Urea >16 mmol/L ( No response to IV fluids)
5. Arterial Oxygen Saturation <76 mmHg

Within 48 hours

1. Serum Calcium <2 mmol/L
2. Serum Albumin <34 g/L
3. LDH >219 units/L
4. AST/ALT >96 units/L

Further Reading

• Pancreatitis - What is Pancreatitis?
• What Causes Pancreatitis?
• Pancreatitis Symptoms
• Pancreatitis Diagnosis
• Pancreatitis Complications
• Pancreatitis Treatments

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