Acute pancreatitis at the beginning of the 21st century: The state of the art

Table 1 Ranson’s criteria for prediction of severity of acute pancreatitis

On admission	During initial 48 h
Age > 55 yr	Hemoglobin falls below 10 mg/dL
White cell count < 16 × 109/L	Blood urea nitrogen increases by > 5 mg/dL
Lactate dehydrogenase > 350 U/L	Calcium < 8 mg/dL
Aspartate aminotransferase > 250 U/L	PaO2 < 60 mmHg (8 kPa)
Glucose > 200 mg/dL	Base deficit > 4 mEq/L
	Fluid sequestration > 6 L

PaO₂: Arterial partial pressure of oxygen.

Table 2 Glasgow (Imrie) severity scoring system for acute pancreatitis

Age > 55 yr

White cell count > 15 × 109/L

PaO2 < 60 mmHg (8 kPa)

Serum lactate dehydrogenase > 600 U/L

Serum aspartate aminotransferase > 200 U/L

Serum albumin < 32 g/L

Serum calcium < 2 mmol/L

Serum glucose > 10 mmol/L

Serum urea > 16 mmol/L

Table 3 Modified multiple organ dysfunction score

Organ system involved	Score
	1	2	3	4	5
Cardiovascular PAHR (beats/min)	≤ 10	10-15	30-15	20-30	> 30
Respiratory PaO2/FiO2 (mmHg)	> 300	300-225	150-225	75-150	< 75
Renal creatinine (&mgr;mol/L)	< 100	100-200	200-350	350-500	> 500
Neurological glasgow coma score	15	14-13	12-10	9-7	≤ 6
Hematological platelet count (× 109/L)	> 120	80-120	50-80	20-50	≤ 20
Hepatic bilirubin (&mgr;mol/L)	< 20	20-60	60-120	120-240	> 240

PAHR: Pressure-adjusted heart rate [heart rate × (right atrial pressure/mean arterial pressure]; FiO₂: Fraction of inspired oxygen.

Table 4 Sequential organ failure assessment score (SOFA)

Organ system involved	Score
	1	2	3	4	5
Cardiovascular	No hypotension	MAP < 70 mmHg	Dopamine or dobutamine (any dose)	Dopamine > 5 &mgr;g/kg per min or adrenaline (epinephrine) < 0.1 &mgr;g/kg per min or noradrenaline (norepinephrine) < 0.1 &mgr;g/kg per min	Dopamine < 0.1 &mgr;g/kg per min or > 15 &mgr;g/kg per min or adrenaline > 0.1 &mgr;g/kg per min or noradrenaline > 0.1 &mgr;g/kg per min
Respiratory PaO2/FiO2 (mmHg)	> 400	400-300	300-200	200-1001	≤ 1001
Renal creatinine (&mgr;mol/L)	< 100	100-200	200-350	350-500	> 500
Neurological glasgow coma score	15	14-13	12-10	9-7	≤ 6
Haematological platelet count (× 109/L)	> 150	150-100	100-50	20-50	≤ 20
Hepatic bilirubin (&mgr;mol/L)	< 20	20-60	60-120	120-240	> 240

¹These values are calculated with ventilatory support. MAP: Mean arterial pressure; SOFA: Sequential organ failure assessment, and is calculated as the sum of the scores for the individual organs.

Table 5 Acute pancreatitis graded with CT and CT severity index table

Grade	CT finding	Points	Necrosis		Severity index
			Percentage	Additional points
A	Normal pancreas	0	0	0	0
B	Pancreatic enlargement	1	0	0	1
C	Pancreatic inflammation and/or peripancreatic fat	2	< 30	2	4
D	Single peripancreatic fluid collection	3	30-50	4	7
E	Two or more fluid collections and/or retroperitoneal air	4	> 50	6	10