A comparative study of methods for the prediction of severity of attacks of acute pancreatitis

Abstract

Diagnostic peritoneal lavage was carried out in 79 patients with acute pancreatitis, at a mean time of 7 h after admission to hospital. The presence of more than 10 ml of free peritoneal fluid, brown-coloured free fluid or mid-straw-coloured lavage fluid was the criterion used for the prediction of a severe attack by lavage. Prior to lavage the attack was assessed as mild or severe by the clinician and reassessed by him at 24 and 48 h. All attacks were finally classified as mild or severe by means of a simple clinical grading scheme. There were 61 mild and 18 severe attacks (including 4 deaths). Initial clinical assessment correctly predicted only 39 per cent of the severe attacks compared with a 72 per cent succwss rate for diagnostic lavage. All the mild attacks were correctly predicted by clinical assessment but lavage was wrong in 3 out of 61 cases (95 per cent success rate). By 48 h after admission clinical assessment was comparable to systems using multiple criteria in its predictive value, success rates being 83 per cent and 82 per cent respectively for prediction of severe attacks. We did not find either the presence of methaemalbumin in the serum or the presence of hypocalcaemia to be of additional value. Diagnostic peritoneal lavage was the most accurate early guide to severity, and correctly predicted all patients who developed shock or died.

Prediction of Severe Acute Pancreatitis at Admission to Hospital Using Artificial Neural Networks

“…Clinical assessment alone is a poor predictor of severity of AP [24], and no AP-specific scoring model for clinical use is available on admission, including the Ranson score [1], the Glasgow severity score [3], and the Balthazar scoring system [2]. The APACHE II score provides a general measure of the severity of disease, and is designed for adult patients admitted to the intensive care unit [4].…”

A prospective study of clinical, biochemical and radiological features in pancreatitis

“…(Michael J. Mc Mohan et al) Rest of the cases were defined as mild. 4 All of these studies, included clinical exam were done at the time of admission and follow-up studies were not performed in any case. On the basis of factor scoring system the severity of acute pancreatitis was predicted as described by modified glasgow prognostic criteria.…”

“…In this assay both lipase anc. 4 lipoprotein lipase arc measured however, if colipase and a bile salt such as sodium deoxy cholate are included, the reaction rate and analytical sensitivity of pancreatic lipase in increased, while that of lipoprotein lipase is eliminated.…”

“…Mohan had showed a positive predictive value of 82%, which was slightly higher than the present study. 4 …”

Assessment of Severity in Acute Pancreatitis: Use of Prognostic Factors

“…Other studies have attempted to evaluate the value of a single factor such as plasma fibrinogen level [7], total compliment activity [12], hypocalcemia [9] and serum methemalbumin [13] estimation to identify severe pancreatitis. Subsequent studies have failed to confirm the value of some of these factors in predicting severity [7,14].…”