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Global Translational Medicine Prognostic indicators and management of SAP

Table 2. Ranson criteria for acute pancreatitis (iii) Presence of pancreatic necrosis on computed
tomography (CT) scan.
Criteria Scoring
On admission Mortality was 2% for a score of zero, 18% for a score of
Age >55 years one, 48% for a score of two, and 67% for a score of three.
Similarly, the percentage of infections increased with the
Hyperleukocytosis >16000/mm 3 score: 2% for a score of 0, 13% for a score of 1, 48% for a
Blood glucose >2 g/L (11 mmol/L) score of 2, and 53% for a score of 3. The MVFS was present
Lactate dehydrogenase >350 UI/L (1.5 N) in 24, 50, 80, and 100% of cases, respectively, corresponding
Aspartate aminotransferase >250 UI/L (6 N) to scores of zero, one, two, or three. 29
Within the first 48 h Other authors have explored creating computer
Fall in hematocrit >10 software in research protocols, aiming to combine all the
Blood urea >50 mg/L (8.3 mmol/L) clinicobiological data in an artificial neural network to
Blood calcium < 80 mg/L (2 mmol/L) produce a highly reliable prediction of MVFS in SAP. 30,31
PO < 60 torr (mmHg) For instance, a Swedish team combined just four factors
2 (age, peak creatinine level during the first 72 h, need
Bicarbonate (HCO ) deficiency >4 mEq/L
-
3 for mechanical ventilation, and pathological history) to
Fluid sequestration >6 L achieve better accuracy (AUC = 0.862) than the APACHE
II score (AUC = 0.781) and the Ranson score (AUC = 0.655)
Table 3. Imrie scoring for acute pancreatitis in detecting the severity of the condition. 32
Criteria Scoring 2.1.4. Radiological criteria
Age >55 years In standard radiograph films, the presence of left pleural fluid
Hyperleukocytosis >15000/mm 3 effusion constitutes an element of diffusion and, therefore,
PO < 60 Torr (mmHg) reflects the severity of the disease Conversely, abdominal
2
Lactate dehydrogenase >660 UI/L ultrasound has no role in the diagnosis of severity as the
Blood glucose >1.80 g/L (10 mmol/L) echo of necrotic fat is weak and difficult to distinguish
Blood urea >50 mg/L (8.3 mmol/L) from pancreatic edema, leading to misclassification of
the severity of the condition. However, ultrasound plays
33
Blood calcium < 80 mg/L (2 mmol/L) a greater role in etiological investigation, particularly
Blood albumin < 32 g/L in detecting biliary lithiasis, with a high sensitivity and
Aspartate aminotransferase >100 UI/L specificity approaching 100%. 34,35 Ultrasound should
be performed early, as fasting will rapidly induce the
and metabolic function (Table 4). Although it is not specifically formation of vesicular sludge, which falsely increases the
36
designed for biliary pancreatitis (BP), it applies to any severe rate of SAP attributed to biliary causes. It can also aid in
condition. It can be obtained within the first 24 h and can be detecting local complications (collections and abscesses)
repeated regularly to monitor the disease and therapeutic and vascular complications through Doppler ultrasound.
response. In most studies, it has been shown to be superior to In contemporary practice, the indications for CT scans
2
the Ranson and Imrie scores in detecting the severity of BP. must be rigorously established, as not all cases of AP
27
The APACHE-O score, which correlates with patient obesity warrant this imaging modality. The normal density of the
by adding two points when the BMI exceeds 30, exhibits pancreatic gland is between 100 and 150 HU (Hounsfield
an even greater discriminatory value. The combination of units). The Balthazar scannographic severity index,
28
the APACHE II with the CRP level demonstrated a better which correlates well with morbidity and mortality, is an
37
prediction of severity (area under the curve [AUC] = 0.82, important diagnostic tool. It is best assessed at the 72 h,
nd
specificity = 71%, and sensitivity = 87%) compared to its as the injection of contrast medium before this time may
isolated assessment (AUC = 0.74). aggravate pancreatic necrosis through alteration of the
38
In a recent Japanese study, a new prognostic score for pancreatic microcirculation, and necrosis does not begin
nd
severe pancreatitis was developed, based on three simple to delineate itself until the 72 h. The CT severity index
criteria assessed on patient admission, with each item (CTSI), combining the Balthazar score and the extent of
scored by one point: glandular necrosis (Table 5), is also of great prognostic value.
(i) Blood urea ≥ 25 mg/dL; A CTSI score of ≥ 7 points is correlated with a
(ii) Lactate dehydrogenase ≥ 900 UI/L; complication rate of approximately 92% and a mortality

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