Early phase of acute pancreatitis: Assessment and management

Table 1 Prognostic criteria of Ranson

On admission	After 48 h
Age > 55 yr	Hematocrit fall > 10%
White blood cell count > 16000/mL	BUN increase > 1.8 mmol/L
Blood glucose concentration > 11.1 mmol/L	Serum calcium < 2 mmol/L
LDH > 350 IU/L	PaO2 < 60 mmHg
ASAT > 250 IU/L	Base deficit > 4 mmol/L
	Fluid sequestration > 6 L

ASAT: Aspartate aminotransferase; BUN: Blood urea nitrogen; LDH: Lactate dehydrogenase; PaO₂: Partial pressure of arterial oxygen.

Table 2 Bedside index of severity in acute pancreatitis score and observed mortality by bedside index of severity in acute pancreatitis score score

BUN > 8.9 mmol/L
Impaired mental status (Glasgow coma scale < 15)
SIRS, defined by the presence of two or more
Temperature	< 36 °C or > 38 °C (< 96.8 °F or > 100.4 °F)
Heart rate	> 90 per minute
Respiratory rate	> 20 per minute or PaCO2 < 32 mmHg
White blood cell count	< 4000/mL or > 12000/mL or > 10% immature neutrophils
Age > 60 yr
Pleural effusion
BISAP score	Mortality (%)
0	0.1-0.2
1	0.5-0.7
2	1.9-2.1
3	5.3-8.3
4	12.7-19.3
5	22.5-26.7

BUN: Blood urea nitrogen; PaCO₂: Partial pressure of arterial carbon dioxide; SIRS: Systemic inflammatory response syndrome.

Table 3 Balthazar score

Grade A	Normal pancreas
Grade B	Focal or diffuse enlargement of the pancreas
Grade C	Pancreatic changes associated with peripancreatic inflammation
Grade D	Single fluid collection
Grade E	Two or more fluid collections and/or presence of gas within the pancreas or within peripancreatic inflammation

Table 4 Computed tomography severity index

Extent of necrosis	Points
Absence of necrosis	0
< 30% necrosis	2
30%-50% necrosis	4
> 50% necrosis	6
Balthazar score
A	0
B	1
C	2
D	3
E	4

Maximum score 10 points.