Korean J Gastroenterol.  2009 Oct;54(4):205-211. 10.4166/kjg.2009.54.4.205.

Evaluation of Severity in Acute Pancreatitis

• Ryu JK

• KMID: 783225
• DOI: http://doi.org/10.4166/kjg.2009.54.4.205

Abstract

Acute pancreatitis has a variable etiology and natural history, and some patients have severe complications with a significant risk of death. The prediction of severe disease should be achieved by careful ongoing clinical assessment coupled with the use of a multiple factor scoring system and imaging studies. Over the past 30 years several scoring systems have been developed to predict the severity of acute pancreatitis. However, there are no complete scoring index with high sensitivity and specificity till now. The interest in new biological markers and predictive models for identifying severe acute pancreatitis testifies to the continued clinical importance of early severity prediction. Among them, IL-6, IL-10, procalcitonin, and trypsinogen activation peptide are most likely to be used in clinical practice as predictors of severity. Even if contrast-enhanced CT has been considered the gold standard for diagnosing pancreatic necrosis, early scanning for the prediction of severity is limited because the full extent of pancreatic necrosis may not develop within the first 48 hour of presentation.

Keyword

Acute pancreatitis; Severity; Scoring system

MeSH Terms

APACHE
Age Factors
Blood Urea Nitrogen
C-Reactive Protein/analysis
Creatine/analysis
Cytokines/metabolism
Humans
Pancreatitis, Acute Necrotizing/*diagnosis
Prognosis
*Severity of Illness Index
Tomography, X-Ray Computed

Reference

1. Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006; 101:2379–2400.

2. Uhl W, Warshaw A, Imrie C, et al. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology. 2002; 2:565–573.

3. Pandol SJ, Saluja AK, Imrie CW, Banks PA. Acute pancreatitis: bench to the bedside. Gastroenterology. 2007; 132:1127–1151.

4. Bradley EL III. Atlanta redux. Pancreas. 2003; 26:105–106.

5. Vege SS, Gardner TB, Chari ST, et al. Low mortality and high morbidity in severe acute pancreatitis without organ failure: a case for revising the Atlanta classification to include “moderately severe acute pancreatitis”. Am J Gastroenterol. 2009; 104:710–715.

6. Bollen TL, Besselink MG, van Santvoort HC, et al. Toward an update of the Atlanta classi. cation on acute pancreatitis: review of new and abandoned terms. Pancreas. 2007; 35:107–113.

7. Bollen TL, van Santvoort HC, Besselink MG, et al. The Atlanta Classification of acute pancreatitis revisited. Br J Surg. 2008; 95:6–21.

8. Morgan DE. Imaging of acute pancreatitis and its complications. Clin Gastroenterol Hepatol. 2008; 6:1077–1085.

9. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974; 139:69–81.

10. Imrie CW. Classification of acute pancreatitis and the role of prognostic factors in assessing severity of disease. Schweiz Med Wochenschr. 1997; 127:798–804.

11. Johnson CD, Toh SK, Campbell MJ. Combination of APACHE-II score and obesity score (APACHE-O) for the prediction of severe acute pancreatitis. Pancreatology. 2004; 4:1–6.

12. Ogawa M, Hirota M, Hayakawa T, et al. Development and use of a new staging system for severe acute pancreatitis based on a nationwide survey in Japan. Pancreas. 2002; 25:325–330.

13. Drew PJ, Monson JR. Artificial neural networks. Surgery. 2000; 127:3–11.

14. Mofidi R, Powell TI, Brabazon A, et al. Prediction of the exact degree of internal carotid artery stenosis using an artificial neural network based on duplex velocity measurements. Ann Vasc Surg. 2005; 19:829–837.

15. Mofidi R, Deans C, Duff MD, de Beaux AC, Paterson Brown S. Prediction of survival from carcinoma of oesophagus and oesophagogastric junction following surgical resection using an artificial neural network. Eur J Surg Oncol. 2006; 32:533–539.

16. Halonen KI, Leppäniemi AK, Lundin JE, Puolakkainen PA, Kemppainen EA, Haapiainen RK. Predicting fatal outcome in the early phase of severe acute pancreatitis by using novel prognostic models. Pancreatology. 2003; 3:309–315.

17. Mofidi R, Duff MD, Madhavan KK, Garden OJ, Parks RW. Identification of severe acute pancreatitis using an artificial neural network. Surgery. 2007; 141:59–66.

18. Wu BU, Johannes RS, Sun X, et al. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008; 57:1698–1703.

19. Singh VK, Wu BU, Bollen TL, et al. A prospective evaluation of the bedside index for severity in acute pancreatitis score in assessing mortality and intermediate markers of severity in acute pancreatitis. Am J Gastroenterol. 2009; 104:966–971.

20. Ueda T, Takeyama Y, Yasuda T, et al. Simple scoring system for the prediction of the prognosis of severe acute pancreatitis. Surgery. 2007; 141:51–58.

21. Lee BJ, Kim CD, Jung SW, et al. Analysis of the factors that affect the mortality rate in severe acute pancreatitis. Korean J Gastroenterol. 2008; 51:25–33.

22. Lankisch PG, Weber-Dany B, Hebel K, Maisonneuve P, Lowenfels AB. The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratification of nonsevere disease. Clin Gastroenterol Hepatol. 2009; 7:702–705.

23. Brown A, Orav J, Banks PA. Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis. Pancreas. 2000; 20:367–372.

24. Remes-Troche JM, Duarte-Rojo A, Morales G, Robles-Diaz G. Hemoconcentration is a poor predictor of severity in acute pancreatitis. World J Gastroenterol. 2005; 11:7018–7023.

25. Brown A, James-Stevenson T, Dyson T, Grunkenmeier D. The Panc 3 score: a rapid and accurate test for predicting severity on presentation in acute pancreatitis. J Clin Gastroenterol. 2007; 41:855–858.

26. Wu BU, Johannes RS, Conwell DL, Banks PA. Early hemoconcentration predicts increased mortality only among transferred patients with acute pancreatitis. Pancreatology. 2009; 9:639–643.

27. Wilson C, Heath DI, Imrie CW. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg. 1990; 77:1260–1264.

28. Sandberg AA, Borgstrom A. Early prediction of severity in acute pancreatitis. Is this possible? JOP. 2002; 3:116–125.

29. Neoptolemos JP, Kemppainen EA, Mayer JM, et al. Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. Lancet. 2000; 355:1955–1960.

30. Wu BU, Johannes RS, Sun X, Conwell DL, Banks PA. Early changes in blood urea nitrogen predict mortality in acute pancreatitis. Gastroenterology. 2009; 137:129–135.

31. Muddana V, Whitcomb DC, Khalid A, Slivka A, Papachristou GI. Elevated serum creatinine as a marker of pancreatic necrosis in acute pancreatitis. Am J Gastroenterol. 2009; 104:164–170.

32. Mayer J, Rau B, Gansauge F, Beger HG. Inflammatory mediators in human acute pancreatitis: clinical and pathophysiological implications. Gut. 2000; 47:546–552.

33. McKay CJ, Gallagher G, Brooks B, Imrie CW, Baxter JN. Increased monocyte cytokine production in association with systemic complications in acute pancreatitis. Br J Surg. 1996; 83:919–923.

34. Mentula P, Kylänpää ML, Kemppainen E, et al. Early prediction of organ failure by combined markers in patients with acute pancreatitis. Br J Surg. 2005; 92:68–75.

35. Kylänpää-Bäck ML, Takala A, Kemppainen E, Puolakkainen P, Haapiainen K, Repo H. Procalcitonin strip test in the early detection of severe acute pancreatitis. Br J Surg. 2001; 88:222–227.

36. Modrau IS, Floyd AK, Thorlacius-Ussing O. The clinical value of procalcitonin in early assessment of acute pancreatitis. Am J Gastroenterol. 2005; 100:1593–1597.

37. Hedström J, Korvuo A, Kenkimäki P, et al. Urinary trypsinogen-2 test strip for acute pancreatitis. Lancet. 1996; 347:729–730.

38. Lempinen M, Kylänpää-Bäck ML, Stenman UH, et al. Predicting the severity of acute pancreatitis by rapid measurement of trypsinogen-2 in urine. Clin Chem. 2001; 47:2103–2107.

39. Balthazar EJ. CT diagnosis and staging of acute pancreatitis. Radiol Clin North Am. 1989; 27:19–37.

40. Balthazar EJ. Staging of acute pancreatitis. Radiol Clin North Am. 2002; 40:1199–1209.

41. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990; 174:331–336.

42. Simchuk EJ, Traverso LW, Nukui YM, Kozarek RA. Computed tomography severity index is a predictor of outcomes for severe pancreatitis. Am J Surg. 2000; 179:352–355.

43. Mortele KJ, Wiesner W, Intriere L, et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. AJR Am J Roentgenol. 2004; 183:1261–1265.