Severe acute pancreatitis: Pathogenetic aspects and prognostic factors

Table 1 Predictors of severity of acute pancreatitis

Severity predictor	Reference
Multifactorial scoring system
Ranson, Imrie, APACHE II	[14]
Clinical data
Age	[108]
Etiology	[108]
Obesity	[63,109]
Simple prognostic scores
BUN (=/> 25 mg/dL), LDH (=/> 900 IU/L) and PN on CE-CT	[104]
Age, highest serum creatinine (within 72 h), chronic health status and requirement for mechanical ventilation	[119]
Inflammatory markers:
IL-6, IL-8	[10]
PL-A2, CRP	[64]
PMN-elastase	[122]
TAP	[123]
PCT	[124]
CT-scoring index (CTSI)	[140]

PN: Pancreatic necrosis; CE-CT: Contrast enhanced computed tomography; IL-6: Interleukin-6; IL-8: Interleukin-8; PL-A2: Pancreatic phospholipase A2; TAP: Trypsinogen activation peptide; CRP: C-rective protein; PTC: procalcitonin; PMN: Polymorphonuclear cells; LDH: Lactate dehydrogenase.

Table 2 Early predictors of severity

Marker		Period	Reference
Clinical:	Obesity	on admission	[111,112]
Radiological:	Abnormal chestradiograph	within 24 h	[21]
Laboratory:	Serum BUN	within the 1st 24 h	[104]
	Serum creatinine	within the 1st 24 h	[21]
	Hematocrit	on admission	[133]
	Proteinuria	2nd d of admission	[111]
	CRP	24-48 h	[129]
	MMP-9	1-48 h of admission	[132]
	SAA	within the 1st 24 h	[43]
	IL-6, IL-8	within the 1st 24 h	[10]
	IL-18	within the 1st 48 h	[28]
	Trypsinogen-2	on admission	[131]
	Trypsin-2 AAT	on admission	[131]
Factors (in biliary pancreatitis) predicting need for ICU:
	Heart rate, Glucose,
	BUN, WBC&CRP	on admission	[136]

CRP: C-reactive protein, MMP-9: Matrix metalloproteinase-9; SAA: Serum amyloid A; IL-6, 8, 18: Interleukins 6, 8 and 18; BUN: Blood urea nitrogen; WBC: White blood cell count, trypsin-2; AAT: Trypsin-2-alpha-1-antitrypsin.

Table 3 Predictors of pancreatic necrosis

Marker	Reference
1 C-reactive protein (CRP)	[48,148]
2 Serum lactate dehydrogenase (LDH)	[153]
3 Procalcitonin (PCT)	[151]
4 Serum amyloid A (SAA)	[14]
5 Serum macrophage migration inhibitory
factor (MIF)	[152]
6 Contrast enhanced CT (CE-CT)	[153]

Table 4 Markers of infected pancreatic necrosis

Marker	Reference
1 C-reactive protein (CRP)	[64]
2 Procalcitonin (PCT)	[64,124]
3 Serum amyloid A (SAA)	[14]
4 Interleukin-6, 8 (IL-6, IL-8)	[64]
5 Soluble intracellular adhesion molecule (sICAM-1)	[58]
6 Reactive nitrogen intermediates (RNIs)	[155]
7 US- or CT-guided FNA	[14,60,61]

Table 5 Markers of mortality

Marker	Reference
1 Obesity	[111,112]
2 Serum creatinine > 2 mg/dL	[21]
3 Pleura effusion on chest radiograph	[21]
4 Early nonenhanced CT	[157]
5 Multiorgan dysfunction syndrome (MODS)	[6,92]
6 Pancreatic necrosis (PN)	[6,92]
7 Infected pancreatic necrosis (IPN)	[6,92]
8 Interleukin-6 (IL-6)	[90]
9 Reactive nitrogen intermediates (RNIs)	[58,156]