Predicting the Severity of Acute Pancreatitis: Choose the Right Horse Before Hitching the Cart

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

“…A rise in hematocrit within the fi rst but rare clinical outcome in AP, recent revised classifi cations of disease severity have focused on persistent organ failure and pancreatic necrosis as the most clinical relevant outcomes. Th is notion is further supported by expert opinions, stating that accurate prediction of severity requires the end point for the prediction to be causally associated with severity ( 30 ). Furthermore, persistent organ failure develops within the fi rst few days in the majority of patients, and is considered to be the main determinant of severity in the early phase of AP.…”

Determinant-Based Classification of Acute Pancreatitis Severity

“…First, it is based on actual factors of severity rather than factors that are predictive of severity. 67 A recent example of this is the measurement of angiopoietin-2, a marker of vascular leak syndrome, in predicting persistent organ failure. 62 However, these scoring systems are all plagued by a significant misclassification error which limits their utility in clinical practice and in recruitment of individual patients into clinical trials.…”

Initial Medical Treatment of Acute Pancreatitis: American Gastroenterological Association Institute Technical Review

“…Death, single or multiple persistent organ failure (>48 hours), and infected pancreatic and/or peripancreatic necrosis are the clinical outcomes of importance in AP. 28 Hospital stay, need for and length of intensive care unit stay, and need for interventions are surrogate markers for the important clinical outcomes mentioned here, 29 but are commonly reported in most of the studies along with transient organ failure, which does not qualify to make the diagnosis of severe acute pancreatitis (SAP). A list of all outcomes with their respective ordinal ranking is shown in Supplementary Table 3.…”