Clinical Assessment and Risk Stratification – Risk Assessment

In 1974, the Ranson criteria was created to predict mortality in acute pancreatitis based upon demographic data and the measurement of several haematological, biochemical, and physiological fields.

Ranson criteria

At admission:

  • Age >55
  • WCC >16
  • Glucose >11
  • AST >250
  • LDH>350

At 48 hours:

  • Calcium <8.0 mg
  • Haematocrit fall >10%
  • PO2 <60
  • Urea increased by 1.8
  • Base excess <-4
  • Sequestration of fluids >6 L

In the more recent past however, several other ‘severity scores’ have superseded the original Ranson score.

An international symposium, held in Atlanta in 1992, established a clinically based classification system for predicting acute severe pancreatitis. The criteria and their timings can be seen by selecting the links below [6].

Initial assessment

APACHE II score >8 is an ICU scoring system based on a variety of parameters; helpful online programs are widely available to aid calculation.

24 hours after admission

Glasgow prognostic criteria (Imrie’s criteria)

The Glasgow system is a simple prognostic system that uses age, and 7 laboratory values collected during the first 48 hours following admission for pancreatitis, to predict severe pancreatitis. It is applicable to both biliary and alcoholic pancreatitis.

A point is assigned if a certain breakpoint is met at any time during that 48-hour period.

The parameters and breakpoints are:

  • Age >55 years = 1 point
  • Serum albumin <32 g/L (3.2 g/dL) = 1 point
  • Arterial PO2 on room air <8 kPa (60 mmHg) = 1 point
  • Serum calcium <2 mmols/L (8 mg/dL) = 1 point
  • Blood glucose >10.0 mmols/L (180 mg/dL) = 1 point
  • Serum LDH >600 units/L = 1 point
  • Serum urea nitrogen >16.1 mmols/L (45 mg/dL) = 1 point
  • WBC count >15 x 10⁹/L (15 x 10³/microlitre) = 1 point

The addition of the parameter points yields the Glasgow prognostic criteria. The score can range from 0 to 8. If the score is >2, the likelihood of severe pancreatitis is high. If the score is <3, severe pancreatitis is unlikely.

Learning Bite

Any evidence of systemic effects indicates severe pancreatitis and a patient at risk of a poor outcome.

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