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Global Translational Medicine Prognostic indicators and management of SAP

Table 4. The Acute Physiology and Chronic Health Evaluation (APACHE) II score items
Physiological variable Abnormal upper limit Abnormal lower limit
+4 +3 +2 +1 0 +1 +2 +3 +4
Temperature (°C) ≥ 41 39 – 40.9 38.5 – 38.9 36 – 38.4 34 – 35.9 32 – 33.9 30 – 31.9 ≤ 29.9
Mean arterial pressure (mmHg) ≥ 160 130 – 159 110 – 129 70 – 109 50 – 69 ≤ 49
Pulse ≥ 180 140 – 179 110 – 139 70 – 109 50 – 69 40 – 54 ≤ 39
Respiratory frequency ≥ 50 35 – 49 25 – 34 12 – 24 10 – 11 6 – 9 ≤ 5
Fraction of inspired oxygen (FiO ) ≥ 0.5 ≥ 500 350 – 499 200 – 349 70 – 200 61 – 70 55 – 60 ≤ 55
2
FiO ≤ 0.5
2
Arterial pH ≥ 7.7 7.7 – 7.69 7.5 – 7.59 7.33 – 7.49 7.25 – 7.32 7.15 – 7.24 ≤ 7.15
Natremia (mmol/l) ≥ 180 160 – 179 155 – 159 150 – 154 130 – 149 120 – 129 111 – 119 ≤ 110
K blood rate (mmol/l) ≥ 7 6 – 6.9 5.5 – 5.9 3.5 – 5.4 3 – 3.4 2.5 – 2.9 ≤ 2.5
Creatininemia (mg/dL) (in the event of ≥ 3.5 2 – 3.4 1.5 – 1.9 0.6 – 1.4 ≤ 0.6
renal failure, the score is doubled)
Hematocrit (%) ≥ 60 50 – 59.9 46 – 49.9 30 – 45.9 20 – 29.9 ≤ 20
Leukocytes (total/mm ) ≥ 40 20 – 39.9 15 – 19.9 3 – 14.9 1 – 2.9 ≤ 1
3
15-Glasgow neurological score
Total acute physiology score
Notes: The APACHE II score is made up of the sum of total APS, the points for age, and the points for chronic diseases. The allocation of points
depending on age is as follows: (i) < 44=0 points; (ii) 45 – 54=2 points; (iii) 55 – 64=3 points; 65 – 74=5 points; and (iv) ≥ 75=6 points. The allocation
of points for chronic disease: if the patient has any kind of severe organic insufficiency or immune depression, points should be assigned as follows: (i)
In the non-operative context or post-operatively after urgent surgery (5 points) and (ii) post-operatively after elective surgery (2 points).

rate of 17%. In addition, CT analysis incorporates more reliable than CT in detecting choledocholiths or
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prognostic factors not included in the severity index: pancreatic calculi. Cholangio-MRI, with its ability to map
41
ascites, pleural effusion, cephalic location of necrosis, and the biliary-pancreatic tree, should be used in the etiological
complications of flows (infection, fistula, pseudoaneurysm, investigation of so-called idiopathic pancreatitis to identify
and venous thrombosis). In the same vein, another anatomical anomalies or early cancers of the biliary-
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CTSI based exclusively on the presence of signs of extra- pancreatic junction. MRI is believed to have a greater
pancreatic diffusion (pleural, retroperitoneal, and ascites), prognostic value than CT in these cases.
the Epic score (extra-pancreatic inflammation on CT),
has been tested. In a pilot study, this new concept enabled All these elements have recently converged into a
the identification of patients likely to develop SAP on the Japanese radio-biological severity classification. This new
st
1 day of hospitalization (AUC = 0.91, sensitivity = 100%, classification integrates eight biological items, the patient’s
and specificity = 70.8%), pending validation in a larger age, and scannographic data. The calculation is based on
series. Organized pancreatic necrosis, or “necoma,” is a the sum of these elements (Table 6). When the score is <
recent and often underestimated entity that represents 3, mortality is only 0.7%. Between 3 – 6, mortality rises to
a zone of post-necrotic pancreatic tissue, commonly 12.5%, and >6 points, mortality reaches 31% with an AUC
mistaken for a recent pseudocyst. This formation results of 0.86. 42
from the liquefaction of pancreatic necrosis, a process that 2.2. Retrospective elements (complications and
takes 1 – 3 months to manifest. The “necroma” stands out death)
well from the retroperitoneum and can be easily removed
by surgery. The density of this ovoid lesion is greater than 2.2.1. Local complications
20 HU, distinguishing it from the recent pseudocysts, Superinfection of necrosis occurs in 40 – 70% of cases,
whose density does not exceed 10 HU. 2 where necrotic tissue becomes infected with germs
Magnetic resonance imaging (MRI) and cholangio- similar to the flora of the digestive tract (enterococci and
MRI are employed when CT scans are contraindicated enterobacteria), translocating from the colon. The earlier
(for allergic or other reasons). They are more appropriate the necrosis infection, the higher the mortality rate (with
in countries where pancreatitis is predominantly of biliary a peak in the 3 week). Despite recent studies showing a
rd
origin (North Africa and southern Europe), as they are decrease in infection rates to 10 – 40% of cases, mortality

Volume 3 Issue 2 (2024) 4 doi: 10.36922/gtm.2480