Assessing Severity in Acute Pancreatitis

HealthCare

There are several methods for assessing severity in acute pancreatitis. Two common and easy to use methods are:

1. The SIRS score

The presence of SIRS in patients w/ pancreatitis is associated with increased mortality. The higher the number of features of SIRS that are present, the more severe the acute pancreatitis is.
Features of systemic inflammatory response syndrome (SIRS)
Two or more of the following conditions:
Temperature >38.3°C or <36.0°C
Heart rate of >90 beats/minute
Respiratory rate of >20 breaths/minute or PaCO2 of <32 mmHg
WBC count of >12,000 cells/mL, <4000 cells/mL, or >10 percent immature (band) forms

 

2. APACHE II

The APACHE II score is also used to assess the severity of acute pancreatitis.

American College of Gastroenterology (ACG)
“ACG guidelines recommend the following clinical findings associated with a severe course for initial risk assessment:

Patient characteristics:

  • Age >55 years
  • Obesity (body mass index >30 kg/m2)
  • Altered mental status
  • Comorbid disease

SIRS present:

  • Presence of >2 of the following criteria:
  • –Pulse >90 beats/min
  • –Respirations >20/min or PaCO2 <32 mm Hg
  • –Temperature >38 or <36°C
  • –White blood cell count >12,000 or <4,000 cells/mm3 or >10 percent immature neutrophils (bands)

Laboratory findings:

  • Blood urea nitrogen (BUN) >20 mg/dl
  • Rising BUN
  • Hematocrit (HCT) >44 percent
  • Rising HCT
  • Elevated creatinine

Radiology findings:

  • –Pleural effusions
  • –Pulmonary Infiltrates
  • –Multiple or extensive extrapancreatic collections” UTD
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