PAINE #PANCE Pearl – Gastrointestinal



Question

 

What are the some of the pancreatitis scoring systems that are commonly used to estimate severity and mortality?



Answer

 

There are several scoring systems for estimating severity and mortality in pancreatitis.

 

  1. Ranson’s Criteria
    1. This is probably the most well known and estimates severity on admission and mortality after 48 hours:
      1. On Admission
        1. Glucose > 200 mg/dL
        2. AST > 250
        3. LDH > 350
        4. Age > 55
        5. WBC > 16,000
        6. ≥ 3 suggests severe pancreatitis and ICU admission
      2. After 48 hours
        1. > 10% decrease in hematocrit
        2. > 5 mg/dL increase in BUN
        3. < 8 mg/dL in serum calcium
        4. < 60 mmHg in PaO2
        5. > 4 base deficit
        6. > 6L fluids needed
        7. Predicted Mortality
          1. 0-2 – 1%
          2. 3-4 – 15%
          3. 5 – 40%
  2. Bedside Index of Severity in Acute Pancreatitis (BISAP)
    1. Predicts mortality
      1. BUN > 25 mg/dL
      2. GCS < 15
      3. Evidence of SIRS (2 of the following)
        1. Temp < 36oC or > 38oC
        2. Respiration > 20 or PaCO2 < 32 mmHg
        3. Heart rate > 90 bpm
        4. WBC < 4000, > 16,000, or > 10% bands
      4. Age > 60
      5. Imaging reveals pleural effusions
    2. Predicted Mortality
      1. 0-2 – < 2%
      2. 3-5 – > 15%
  3. CT Severity Index (CTSI)
    1. Assesses severity of pancreatitis via contrast enhanced CT and is the the sum of two scores:
      1. Balthazar Score
        1. 0 – normal pancrease
        2. 1 – enlargement of pancrease
        3. 2 – inflammatory changes in pancrease and peripancreatic fat
        4. 3 – defined single peripancreatic fluid collection
        5. 4 – two or more poorly defined peripancreatic fluid collections
      2. Pancreatic Necrosis
        1. 0 – none
        2. 2 – < 30%
        3. 4 – 30-50%
        4. 6 – ≥ 50%
      3. Assessment
        1. 0-3 – mild
        2. 4-6 – moderate
        3. 7-10 – severe
  4. Glasgow-Imrie Criteria for Severity of Acute Pancreatitis
    1. This one has a nice mneumonic (PANCREAS):
      1. PaO2 < 60
      2. Age < 55
      3. Neutrophil (WBC) > 15,000
      4. Calcium < 8 mg/dL
      5. Raised BUN > 45 mg/dL
      6. Enzyme (LDH) > 600 IU/L
      7. Albumin < 3.2 g/dL
      8. Sugar (glucose) > 180 mg/dL
    2. ≥ 3 points suggests severe disease

 


References

  1. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surgery, gynecology & obstetrics. 1974; 139(1):69-81. [pubmed]
  2. Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008; 57(12):1698-703. [pubmed]
  3. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990; 174(2):331-6. [pubmed]
  4. Knipe H, Cuete D.  CT Severity Index in Acute pancreatitis.  Radiopaedia.
  5. Blamey SL, Imrie CW, O’Neill J, Gilmour WH, Carter DC. Prognostic factors in acute pancreatitis. Gut. 1984; 25(12):1340-6. [pubmed]

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