Criteria for the diagnosis and severity stratification of acute pancreatitis

Table 1 Laboratory/clinical criteria for grading the severity of acute pancreatitis

No.	Laboratory/clinical criteria
1	Base excess ≤ -3 mEq/L or shock (systolic blood pressure ≤ 80 mmHg)
2	PaO2 ≤ 60 mmHg (room air) or respiratory failure (artificial respiratory ventilation)
3	BUN ≥ 40 mg/dL or creatininee ≥ 2.0 mg/dL or oliguria (urinary volume ≤ 400 mL/d after hydration)
4	LDH: More than twice higher than the upper limit of normal (≥ 700 IU/L)
5	Serum total Ca ≤ 7.5 mg/dL
6	Platelet count ≤ 1 × 105/mm3
7	CRP ≥ 15 mg/dL
8	Positive score of SIRS criteria ≥ 3
9	Age ≥ 70 yr

One point for each positive factor. Severe acute pancreatitis: total scores ≥ 3 points. BUN: Blood urea nitrogen; LDH: Lactate dehydrogenase; SIRS: Systemic inflammatory response syndrome; CRP: C-reactive protein.

Table 2 Contrast-enhanced computed tomography criteria for grading the severity of acute pancreatitis

Contrast-enhanced computed tomography criteria	Scores
Extension of extrapancreatic inflammatory changes
Anterior pararenal extraperitoneal space	0 point
Root of the mesocolon	1 point
Beyond inferior renal pole	2 points
Unenhanced area in the pancreatic parenchyma (Divide the pancreas into 3 areas for expediency, head, body and tail)
Limited to one area or peripancreatic area	0 point
Extend over 2 areas	1 point
More than 2 areas	2 points

Severe acute pancreatitis: total computed tomography severity scores ≥ 2 points.

Table 3 Verification of the revised severity criteria

Total severity score (points)	Revised severity criteria	Criteria 2002
0	66	77
1	51	31
2	18	15
3	11 (1)	9
4	4	7
5	4 (2)	6
6	2 (1)	3 (1)
7	0	2 (1)
8	0	0
9	0	1
10	0	2 (2)
11	0	2
12	0	1
Total	156 (4)	156 (4)

Results shown are number of patients. Number in parenthesis indicates patients died of acute pancreatitis. The same patients with acute pancreatitis were evaluated by the revised criteria and by the criteria 2002. Total severity score of the revised criteria ≥ 3 points, while that of the criteria 2002 ≥ 2 points was diagnosed as severe acute pancreatitis.

Table 4 Relationship between the revised laboratory/clinical or contrast-enhanced computed tomography severity score and incidence of organ failure

Total severity score (points)	Incidence of organ failure
	Laboratory/clinical	CE-CT
0	1.5%	0.0%
1	7.8%	4.3%
2	5.5%	42.9%
3	36.4%	46.2%
4	50.0%	-
5	75.0%	-
6	100.0%	-

Total number of patients evaluated by laboratory/clinical examinations was 156, whereas contrast-enhanced computed tomography (CE-CT) severity score was evaluated in 142 of these 156 patients at the same time.

Table 5 Relationship between the laboratory/clinical and the contrast-enhanced computed tomography severity scores

Total CE-CT severity score (points)	Total laboratory/clinical severity score (points)							Total
	0	1	2	3	4	5	6
0	0	0	0	0	0	0	0	0
1	56	40	13	5	1	0	0	115
2	3	5	2	1	0	2 (1)	1 (1)	14 (2)
3	2	1	1	3 (1)	3	2 (1)	1	13 (2)
Total	61	46	16	9 (1)	4	4 (2)	2 (1)	142 (4)

Results shown are number of patients. Number of patients died of acute pancreatitis is indicated in parenthesis. In these 142 patients, laboratory/clinical and contrast-enhanced computed tomography (CE-CT) examinations were evaluated at the same time.