Criteria

Diagnosis of acute pancreatitis can be established through a combination of clinical, laboratory, and imaging criteria. Severity scoring tools such as APACHE II, Ranson, or modified Glasgow are in widespread use but add limited value.[8][52][56][65][69] Their use is not generally recommended by evidence-based guidelines.[8][28][47]

International Association of Pancreatology/American Pancreatic Association/American College of Gastroenterology criteria[8][47]

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 (computed tomography [CT], magnetic resonance [MR], ultrasound) criteria

Systemic inflammatory response syndrome (SIRS) criteria with American College of Gastroenterology (ACG) guideline risk factors[8][70]

SIRS criteria are used for the grading of severity, not diagnosis, alongside evaluation of additional patient characteristics and risk factors.

Definition of SIRS met by the presence of at least two of the following criteria:[49]

  • Pulse >90 beats per minute

  • Respiratory rate >20 per minute or partial pressure of carbon dioxide (PaCO₂) <32 mmHg

  • Temperature >100.4°F or <96.8ºF

  • WBC count >12,000 or <4000 cells/mm³, or >10% immature neutrophils (bands)

Additional patient characteristics and factors identified by ACG as indicating severe acute pancreatitis:[8]

Patient characteristics

  • Age >55 years

  • Obesity (body mass index >30 kg/m²)

  • Altered mental status

  • Comorbid disease

Laboratory findings

  • BUN >20 mg/dL

  • Rising BUN

  • Hematocrit (HCT) >44%

  • Rising HCT

  • Elevated creatinine

Radiology findings

  • Pleural effusions

  • Pulmonary infiltrates

  • Multiple or extensive extrapancreatic collections

Revised Atlanta classification[2]

Mild acute pancreatitis

  • No organ failure

  • No local or systemic complications

Moderately severe acute pancreatitis

  • Transient organ failure (<48 hours)

  • Local or systemic complications without persistent organ failure

Severe acute pancreatitis

  • Persistent single or multiple organ failure (>48 hours)

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