Page 42 - GTM-3-2

Global Translational Medicine

REVIEW ARTICLE
Prognostic indicators and management of

severe acute pancreatitis

1,2
Haddadi Saïd * , Rabah Ourdane , Ladjel Khelafi , Yasmina Yahia Messaoud ,
1,2
2,3
1,2
1,2
1,2
Ali Baba , Imène Khadidja Bakalem , Nora Graidia , and Rezki Touati 1,2
1,2
1 Central Hospital of the Army Docteur Mohamed Seghir Nekkache, Kouba, Algiers, Algeria
2 Faculty of Medicine, Algiers 1 University/Benyoucef Benkhedda, Algiers, Algiers Province, Algeria
3 Béni-Messous Mother and Child Hospital, Algiers, Algiers Province, Algeria
Abstract

Severe acute pancreatitis (SAP) is defined according to clinicobiological, radiological,
and evolutionary criteria. In this review, we discuss the main prognostic factors
and propose a therapeutic approach based on recent literature. The treatment of
SAP primarily involves resuscitation and intensive care, with surgery reserved as
a secondary treatment in the event of complications or cases of biliary etiology.
Despite advancements, the prognosis remains guarded for severe forms. A critical
challenge in this emergency context is the early identification of markers that
can guide patients with severe SAP to referent centers with multidisciplinary and
specialized teams. These teams play a dual role: providing optimal acute-phase care
and ensuring long-term monitoring due to potential functional consequences that
may persist post-crisis.

*Corresponding author: Keywords: Severe acute pancreatitis; Multi-visceral failure syndrome; Multidisciplinarity;
Haddadi Saïd Superinfection; Mortality; Functional sequelae
(hcachir@yahoo.fr)
Citation: Saïd H, Ourdane R,
Khelafi L, et al. Prognostic
indicators and management of 1. Introduction
severe acute pancreatitis. Global
Transl Med. 2024;3(2):2480. Severe acute pancreatitis (SAP) is defined as organ failure and/or local complications
doi: 10.36922/gtm.2480
such as necrosis, abscess, or pseudocyst, often necrotic, with a mortality rate of 30%.
1
Received: December 19, 2023 According to the Atlanta Criteria (Table 1), acute pancreatitis (AP) is considered severe
Accepted: March 21, 2024 in the following situations: (i) When the Ranson or IMRIE scores are >3; (ii) when the
APACHE II (Acute Physiology and Chronic Health Examination) score is higher than
Published Online: June 19, 2024
eight; and (iii) when the C-reactive protein (CRP) level at 48 h is over 150 mg/dl. In
2
Copyright: © 2024 Author(s). addition, some authors consider AP severe if it necessitates hospitalization for at least
This is an Open-Access article 3 months or leads to the patient’s death. 3
distributed under the terms of the
Creative Commons Attribution In 2012, the Atlanta Criteria were revised by a panel of experts, who ruled that AP is
License, permitting distribution,
and reproduction in any medium, classified as severe when it leads to a multivisceral failure syndrome (MVFS) persisting
provided the original work is beyond 48 h. Pancreatitis presents as both a medical and surgical emergency, typically
4
properly cited. affecting adults with an average age of 55 (with extremes ranging from 30 – 70 years old),
Publisher’s Note: AccScience with a slight predominance of women. Its frequency is difficult to assess: in 1998, France
Publishing remains neutral with witnessed 16,434 hospitalizations for AP, while the US recorded 250,000 hospitalizations
5
regard to jurisdictional claims in 6
published maps and institutional annually for the same reason. Overall, it is estimated that approximately 80% of cases
affiliations. are moderate, with the remaining 20% being severe. Alcohol and biliary lithiasis account

Volume 3 Issue 2 (2024) 1 doi: 10.36922/gtm.2480