Criteria

Establish the diagnosis of acute pancreatitis through a combination of clinical, laboratory, and imaging criteria.

Severity scoring tools such as APACHE II and Glasgow have limited value and are not generally recommended by evidence-based guidelines.[18][29][48][50][51]

International Association of Pancreatology/American Pancreatic Association/American College of Gastroenterology criteria[18][48]

Two out of three of the following criteria must be met for the diagnosis of acute pancreatitis:

  • Clinical (upper abdominal pain)

  • Laboratory (serum lipase or amylase >3 upper limit of normal)

  • Imaging (CT, MR, ultrasound) criteria.

Ranson criteria (non-gallstone pancreatitis)[17][90]

Used for prediction of severe acute pancreatitis - not diagnosis.

Criteria on admission: age >55 years; glucose >11.1 mmol/L (>200 mg/dL); white blood cell (WBC) count >16 x 10⁹/L (>16 x 10³/microlitre); serum aspartate aminotransferase (AST; serum glutamic-oxaloacetic transaminase [SGOT]) >250 units/L; and serum lactate dehydrogenase (LDH) >350 units/L.

Criteria after 48 hours of admission: haematocrit (Hct) fall >10%; estimated fluid sequestration >6 L; base deficit >4 mEq/L; blood urea nitrogen rise >1.8 mmol/L (>5 mg/dL); serum calcium <2 mmol/L (<8 mg/dL); PO2 <8 kPa (60 mmHg).

Number of criteria and approximate mortality (%):

  • 0 to 2 = 0%

  • 3 to 4 = 15%

  • 5 to 6 = 50%

  • >6 = 100%.

Ranson criteria (gallstone-associated)[17]

Used for prediction of severe acute pancreatitis - not diagnosis.

Criteria on admission: age >70 years; glucose >12.2 mmol/L (>220 mg/dL); WBC count >18 x 10⁹/L (>18 x 10³/ microlitre); serum AST (SGOT) >250 units/L; and serum LDH >400 units/L.

Criteria after 48 hours of admission: Hct fall >10%; estimated fluid sequestration >4 L; base deficit >5 mEq/L; blood urea nitrogen rise >0.7 mmol/L (>2 mg/dL); serum calcium <2 mmol/L (<8 mg/dL).

Balthazar computed tomography (CT) severity index[90][91]

Used for grading of severity - not diagnosis.

CT features and score:

  • I Grade

    • Normal gland = 0

    • Focal/diffuse enlargement = 1

    • Peri-pancreatic inflammation = 2

    • Single pancreatic fluid collection = 3

    • Two or more fluid collections or abscess = 4.

  • II Necrosis

    • None = 0

    • <30% = 2

    • 30% to 50% = 4

    • >50% = 6.

Morbidity and mortality by Balthazar scoring:

(score = morbidity [%]/mortality [%])

  • 0 to 3 = 8%/3%

  • 4 to 6 = 35%/6%

  • 7 to 10 = 92%/17%.

Glasgow prognostic criteria (Imrie's criteria)[92]

The Glasgow system is a simple prognostic system that uses age, and 7 laboratory values collected during the first 48 hours following admission for pancreatitis, to predict severe pancreatitis. It is applicable to both biliary and alcoholic pancreatitis.

A point is assigned if a certain breakpoint is met at any time during that 48-hour period.

The parameters and breakpoints are:

  • Age >55 years = 1 point

  • Serum albumin <32 g/L (<3.2 g/dL) = 1 point

  • Arterial PO2 on room air <8 kPa (<60 mmHg) = 1 point

  • Serum calcium <2 mmol/L (<8 mg/dL) = 1 point

  • Blood glucose >10.0 mmol/L (>180 mg/dL) = 1 point

  • Serum LDH >600 units/L = 1 point

  • Serum urea nitrogen >16.1 mmol/L (>45 mg/dL) = 1 point

  • WBC count >15 x 10⁹/L (>15 x 10³/microlitre) = 1 point.

The addition of the parameter points yields the Glasgow prognostic criteria. The score can range from 0 to 8. If the score is >2, the likelihood of severe pancreatitis is high. If the score is <3, severe pancreatitis is unlikely.

The extrapancreatic inflammation on computed tomography score[52][93][94]

The extrapancreatic inflammation on computed tomography score assesses the severity of acute pancreatitis based on extrapancreatic complications. The score ranges from 0 to 7 based on CT findings. Scores 0 to 3 are associated with 0% mortality; scores 4 to 7 are associated with 67% mortality.

Signs of extrapancreatic inflammation and score:

  • Pleural effusion

    • None = 0

    • Unilateral = 1

    • Bilateral = 2.

  • Ascites in any of these locations: perisplenic, periphepatic, interloop, pelvis

    • None = 0

    • One location = 1

    • More than one location = 2.

  • Retroperitoneal inflammation

    • None = 0

    • Unilateral = 1

    • Bilateral = 2.

  • Mesenteric inflammation

    • Absent = 0

    • Present = 1.

Acute physiology and chronic health evaluation II (APACHE II) score[95]

The APACHE score is commonly used to establish illness severity in the intensive care unit and predict the risk of death. [ APACHE II scoring system Opens in new window ] There is a high risk of death if the score is 25 or above.

Revised Atlanta classification[2]

The revised classification of acute pancreatitis identifies an early and a late phase of the disease. Severity is classified as mild, moderate, or severe.[2] 

  • Mild acute pancreatitis: the most common form, has no organ failure or local or systemic complications, and usually resolves in the first week.

  • Moderately severe acute pancreatitis: presence of transient organ failure (resolves within 48 hours), and/or local complications or exacerbation of comorbid disease.

  • Severe acute pancreatitis: persistent organ failure (>48 hours). Local complications are common and include peri-pancreatic fluid collections, pancreatic and peri-pancreatic necrosis (sterile or infected), pseudocysts, and walled-off necrosis (sterile or infected).

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