Pancreatitis - Prognosis

Prognosis

Severe acute pancreatitis has high mortality rates, especially where necrosis of the pancreas has occurred.

Several scoring systems are used to predict the severity of an attack of pancreatitis. They each combine demographic and laboratory data to estimate severity or probability of death. Examples include APACHE II, Ranson, and Glasgow. Apache II is available on admission; Glasgow and Ranson are simpler but cannot be determined for 48 hours. One form of the Glasgow criteria suggests that a case be considered severe if at least three of the following are true:

• Age > 55 years
• Blood levels:
  • P02 Oxygen < 60mmHg or 7.9kPa
  • White blood cells > 15
  • Calcium < 2 mmol/L
  • Urea > 16 mmol/L
  • Lactate dehydrogenase (LDH) > 600iu/L
  • Aspartate transaminase (AST) > 200iu/L
  • Albumin < 32g/L
  • Glucose > 10 mmol/L

This can be remembered using the mnemonic PANCREAS:

• P02 Oxygen < 60mmHg or 7.9kPa
• Age > 55
• Neutrophilia White blood cells > 15
• Calcium < 2 mmol/L
• Renal Urea > 16 mmol/L
• Enzymes Lactate dehydrogenase (LDH) > 600iu/L Aspartate transaminase (AST) > 200iu/L
• Albumin < 32g/L
• Sugar Glucose > 10 mmol/L