Severity Assessment of Acute Pancreatitis

Cheon, Young Koog

Abstract

Older age (> 55), obesity (BMI > 30), organ failure at admission, and pleural effusion and/or infiltrates are risk factors for severity that should be noted at admission. Tests at admission that are also helpful in distinguishing mild from severe acute pancreatitis include APACHE-II score > or = 8 and serum hematocrit (a value < 44 strongly suggests mild acute pancreatitis). An APACHE-II score that continues to increase for the first 48 h strongly suggests the development of severe acute pancreatitis. In general, an APACHE-II score that increases during the first 48 h is strongly suggestive of the development of severe pancreatitis. Contrast-enhanced CT scan is the best available test to distinguish interstitial from necrotizing pancreatitis, particularly after 2-3 days of illness. Mortality of sustained multisystem organ failure in association with necrotizing pancreatitis is generally > 36%. Transfer to an intensive care unit is recommended if there is sustained organ failure or if there are other indications that the pancreatitis is severe including oliguria, persistent tachycardia, and labored respiration. The early severity assessment is very important to appropriate treatment of acute pancreatitis.