Open AccessCriteria for the diagnosis and severity stratification of acute pancreatitis
Author(s) -
Makoto Ōtsuki,
Kazunori Takeda,
Seiki Matsuno,
Yasuyuki Kihara,
Masaru Koizumi,
Masahiko Hirota,
Tetsuhide Ito,
Keisuke Kataoka,
Motoji Kitagawa,
Kentaro Inui,
Yoshifumi Takeyama
Publication year - 2013
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v19.i35.5798
Subject(s) - medicine , acute pancreatitis , mortality rate , severity of illness , computed tomography , pancreatitis , stage (stratigraphy) , risk stratification , apache ii , intensive care medicine , radiology , intensive care unit , paleontology , biology
Recent diagnostic and therapeutic progress for severe acute pancreatitis (SAP) remarkably decreased the case-mortality rate. To further decrease the mortality rate of SAP, it is important to precisely evaluate the severity at an early stage, and initiate appropriate treatment as early as possible. Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs. Severity can be evaluated by laboratory examinations or by clinical signs, reducing the defect values of the severity factors. Moreover, the severity criteria considered laboratory/clinical severity scores and contrast-enhanced computed tomography (CE-CT) findings as independent risk factors. Thus, CE-CT scans are not necessarily required to evaluate the severity of acute pancreatitis. There was no fatal case in mild AP diagnosed by the CE-CT severity score, whereas case-mortality rate in those with SAP was 14.8%. Case-mortality of SAP that fulfilled both the laboratory/clinical and the CE-CT severity criteria was 30.8%. It is recommended, therefore, to perform CE-CT examination to clarify the prognosis in those patients who were diagnosed as SAP by laboratory/clinical severity criteria. Because the mortality rate of these patients with SAP is high, such patients should be transferred to advanced medical units.