Prognostic Factors in Acute Pancreatitis

Abstract

The assessment of the severity of acute pancreatitis (AP) is a critical early step in its management, as severity of AP predicts prognosis. A range of options are available for assessment of severity in AP, including clinical evaluation, standardized prognostic criteria, computed tomography (CT), and biochemical markers. Clinical assessment has limited accuracy for predicting severity early in the course of AP. Therefore, additional assessment using biochemical and radiologic criteria in combination with standardized criteria is appropriate to determine severity and prognosis in AP; a strategy emphasizing daily assessment of severity should be used. The APACHE II is the scoring system of choice for evaluating severity in AP, although it remains an imperfect tool. Computed tomographic grading of AP and the development of the CT severity index allow for heightened accuracy in the prediction of severity. C-Reactive protein is the standard for serum marker assessment of severity and prognosis in AP; other markers, including interleukin-6, polymorphonuclear elastase, and trypsinogen activation peptide, hold promise. The focus of this review is to examine the role of diagnostic tests in evaluating severity and predicting prognosis among patients with AP and to provide a diagnostic algorithm for initial management.

Serum magnesium levels in patients with the necrotizing and edematous types of acute pancreatitis with and without hypocalcemia

“…In general, the severity of acute pancreatitis is considered to be predictive of the prognosis of the disease according to some specific criteria, such as Ranson's, Glasgow's, the APACHE system and Balthazar's, which differentiate the mild and moderate forms from the severe form (4,6,7) , which were beyond the scope of this study. Our aim was to evaluate the association of necrotizing and edematous types of acute pancreatitis using serum magnesium levels in patients with and without hypocalcemia.…”

What is New in Acute Pancreatitis?

“…Recent trial has shown that, C-reactive protein levels > 150 by 48 hours is shown to have positive predictive value for prediction of severity ranging between 37% -77%, which is similar to APACHE II [12]. Serum CRP an acute phase reactant, peaks about third day after initiation of pain.…”

“…Routine laboratory data A recent multicentric trial has reported significant correlation of serum creatinine > 2 mg/dl and blood sugar > 250 mg/dl measured at admission with mortality. Similarly abnormalities in chest radiographs combined with raised serum creatinine > 2mg/dl have been correlated with higher risk [12].…”

Acute pancreatitis

“…In approximately 20% to 25% of patients, however, it is severe and associated with organ failure and significant morbidity and mortality. 38,39 Determining the severity of acute pancreatitis is critical, as patients at high-risk for severe disease require closer monitoring and possible intervention. Several validated scoring systems are available that aim to predict the severity of acute pancreatitis including Ranson's criteria, the Imrie scoring system, the Acute Physiology and Chronic Health Evaluation (APACHE II) scale, and the CT Severity Index (CTSI) ( Table 2).…”