Management of necrotizing pancreatitis

Table 1 Prognostic accuracy of the APACHE II, the Imrie and Ranson scores, plasma CRP and urinary TAP levels[18]

Scoring System	Sensitivity	Specificity	PPV	NPV	Accuracy
	%	%	%	%	%
Post-symptom 24 hrs
Urinary TAP > 35 nmol/L	58	73	39	86	70
Plasma CRP > 150 mg/L	0	90	0	75	69
Plasma CRP > 150 mg/L
or urinary TAP > 35 nmol/L	58	72	37	86	69
Plasma CRP > 150 mg/L and
urinary TAP > 35 nmol/L	0	92	0	74	70
Post-symptom 48 hrs
Urinary TAP > 35 nmol/L	81	71	42	94	73
Plasma CRP > 150 mg/L	65	73	37	90	72
Plasma CRP > 150 mg/L
or urinary TAP > 35 nmol/L	86	60	35	94	65
Plasma CRP > 150 mg/L and
urinary TAP > 35 nmol/L	60	85	50	90	80
Post-hospitalisation 24 hrs
Urinary TAP > 35 nmol/L	68	74	44	89	73
Plasma CRP > 150 mg/L	47	82	42	84	74
Plasma CRP > 150 mg/L or
urinary TAP > 35 nmol/L	74	66	38	90	68
Plasma CRP > 150 mg/L and
urinary TAP > 35 nmol/L	40	91	57	83	79
APACHE II ≥ 8	63	73	38	88	71
Post-hospitalisation 48 hrs
Urinary TAP > 35 nmol/L	83	72	44	94	74
Plasma CRP > 150 mg/L	86	61	37	94	66
Plasma CRP > 150 mg/L or
urinary TAP > 35 nmol/L	94	49	32	97	58
Plasma CRP > 150 mg/L and
urinary TAP > 35 nmol/L	74	85	58	92	83
APACHE II ≥ 8	56	64	30	85	63
Imrie Score ≥ 3	77	75	44	93	76
Ranson Score ≥ 3	89	64	38	96	69

PPV = positive predictive value; NPV = negative predictive value.

Table 2 Bacteria isolated from operative specimens taken at necrosectomy prior to the introduction of routine antibiotic prophylaxis, Beger et al[29], 1986

Bacteria isolated	No. of patients
Gram - ve aerobic
Escherichia coli	24
Enterobacter aerogenes	16
Pseudomonas aeruginosa	5
Proteus species	5
Klebsiella pneumonia	3
Citrobacter freundi	1
Gram - ve anaerobic
Bacteroides species	5
Gram + ve aerobic
Streptococcus faecalis	6
Staphlococcus aureus	4
Streptococcus viridans	1
Staplococcis epidermidis	1
Others
Mycobacterium tuberculosis	1
Candida species	3

Table 3 Indications for surgical intervention

Absolute	﹒Presence of infected pancreatic necrosis shown by CE-CT or FNAB.
Relative	﹒In a patient with > 50% pancreatic necrosis, failure
	to improve appreciably after 2-3 weeks,
	unexplained deterioration, or a suspicion of infected
	pancreatic necrosis even in the absence of firm
	evidence on CE-CT and FNAB.
	In a patient with > 50% pancreatic necrosis,
	﹒prolonged illness with an unacceptably slow recovery