section name header

Table 154-2

Severe Acute Pancreatitis

Risk Factors for Severity

  • Age >60 years
  • Obesity, BMI >30
  • Comorbid disease (Charlson Comorbidity Index)

Markers of Severity at Admission or within 24 h

  • SIRS-defined by presence of 2 or more criteria:
  • Core temperature <36°C or >38°C
  • Heart rate >90 beats/min
  • Respirations >20/min or PCO2<32 mmHg
  • White blood cell count >12,000/µL, <4000/µL, or 10% bands
  • APACHE II
  • Hemoconcentration (hematocrit >44%)
  • Admission BUN (>22 mg/dL)
  • BISAP Score
    • – (B) BUN >25 mg/dL
    • – (I) Impaired mental status
    • – (S) SIRS: ≥2 of 4 present
    • – (A) Age >60 years
    • – (P) Pleural effusion
  • Organ failure (Modified Marshall Score)
  • Cardiovascular: systolic BP <90 mmHg, heart rate >130 beats/min
  • Pulmonary: PAO2<60 mmHg
  • Renal: serum creatinine >2.0 mg %

Markers of Severity during Hospitalization

  • Persistent organ failure
  • Pancreatic necrosis

Abbreviations: APACHE II, Acute Physiology and Chronic Health Evaluation II; BMI, body mass index; BISAP, Bedside Index of Severity in Acute Pancreatitis; BP, blood pressure; BUN, blood urea nitrogen; SIRS, systemic inflammatory response syndrome.