The majority of patients (around 80%) with acute pancreatitis have mild disease and will improve within 3 to 7 days of conservative management. The overall mortality rate is low (approximately 5%) but this rises to 25% to 30% in severe acute pancreatitis.[8]National Institute for Health and Care Excellence. Pancreatitis. December 2020 [internet publication].
https://www.nice.org.uk/guidance/ng104
[49]Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014 Aug 12;349:g4859.
http://www.ncbi.nlm.nih.gov/pubmed/25116169?tool=bestpractice.com
The cause of pancreatitis should be identified, and a plan to prevent recurrence should be initiated before the patient is discharged from hospital.
Long-term prognosis is based on the aetiology and patient adherence to lifestyle modifications. Acute pancreatitis generally resolves and leaves pancreatic function intact. May progress to recurrent acute pancreatitis or chronic pancreatitis, and the risk is higher among people who smoke or drink alcohol to excess, and in men.[173]Sankaran SJ, Xiao AY, Wu LM, et al. Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology. 2015 Nov;149(6):1490-500.
http://www.gastrojournal.org/article/S0016-5085(15)01175-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/26299411?tool=bestpractice.com
Scoring tools such as APACHE II, Ranson, or Glasgow are in widespread use but add limited value.[49]Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014 Aug 12;349:g4859.
http://www.ncbi.nlm.nih.gov/pubmed/25116169?tool=bestpractice.com
[50]Larvin M. Assessment of severity and prognosis in acute pancreatitis. Eur J Gastroenterol Hepatol. 1997 Feb;9(2):122-30.
http://www.ncbi.nlm.nih.gov/pubmed/9058621?tool=bestpractice.com
[51]Tenner S. Initial management of acute pancreatitis: critical issues during the first 72 hours. Am J Gastroenterol. 2004 Dec;99(12):2489-94.
http://www.ncbi.nlm.nih.gov/pubmed/15571599?tool=bestpractice.com
[52]Papachristou GI, Muddana V, Yadav D, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010 Feb;105(2):435-41.
http://www.ncbi.nlm.nih.gov/pubmed/19861954?tool=bestpractice.com
[53]Wu BU, Johannes RS, Sun X, et al. Early changes in blood urea nitrogen predict mortality in acute pancreatitis. Gastroenterology. 2009 Apr 1;137(1):129-35.
https://www.doi.org/10.1053/j.gastro.2009.03.056
http://www.ncbi.nlm.nih.gov/pubmed/19344722?tool=bestpractice.com
Their use is not recommended by evidence-based guidelines.[18]Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013 Sep;108(9):1400-15.
http://www.ncbi.nlm.nih.gov/pubmed/23896955?tool=bestpractice.com
[48]Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013 Jul-Aug;13(4 suppl 2):e1-15.
http://www.ncbi.nlm.nih.gov/pubmed/24054878?tool=bestpractice.com
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APACHE II scoring system
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Pancreatitis Prognosis Criteria
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