Prediction Of Severity

AP is a mild, self-limited illness with full recovery in 70 to 90% of those patients affected. The remaining patients have severe disease, often with varying degrees of pancreatic necrosis and remote organ failure. Early recognition of severe disease allows clinicians to plan aggressive therapy in an effort to prevent complications and to minimize mortality. Indeed, early referral of patients with severe AP to a specialized care facility has been shown to result in decreased mortality.

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The Ranson criteria, established in 1974, were the first prognostic scoring system developed for AP.1 ' Ranson and colleagues evaluated 43 variables in 100 consecutive patients with AP and identified 11 factors that made it possible to predict both the severity of an attack and the disease-related mortality. When three or more criteria were present after the initial 48 hours of hospitalization, serious illness was observed in one third of patients, with an associated increased risk of death. In contrast, serious illness and death occurred in only 11% and in fewer than 3% of those patients with fewer than three prognostic signs, respectively. In this initial study, most patients had alcohol-induced AP. Later, a similar prognostic scoring

Figure 2-5 CT scan of a patient with an extensive secondary pancreatic infection. Air bubbles are present in the retrocolic spaces on both the right and left sides.

TABLE 2-8 -- Ranson's Early Prognostic Signs in Acute Pancreatitis

Criteria for Pancreatitis Not Due to Gallstones

At Admission

During Initial 48 Hours

Age >55 yr

Hematocrit fall >10 percentage points

WBC >16,000 cells/mm3

BUN elevation >5 mg/100 ml

Blood glucose >200 mg/100 ml

Serum calcium fall to <8 mg/100 ml

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Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

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