Diagnosis of Severe Acute Pancreatitis.

    Severe acute pancreatitis is characterized by persistent organ failure ( > 48 h). Organ failure can be single or multiple. A CT scan or magnetic resonance imaging (MRI) should be obtained to assess for necrosis and/or complications. If a local complication is encountered, management is dictated by clinical symptoms, evidence of infection, maturity of fluid collection, and clinical stability of the patient. Prophylactic antibiotics are not recommended.

Acute necrotizing pancreatitis: computed tomography (CT) scan. Contrast-enhanced
CT scan showing acute pancreatitis with necrosis. Arrow shows partially enhancing body/tail of
pancreas surrounded by fluid with decreased enhancement in the neck/body of the pancreas.

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° or  > 38°C
• Heart rate > 90 beats/min
• Respirations > 20/min or P co 2  < 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 mm Hg, heart rate > 130 beats/min
• Pulmonary: PaO2 < 60 mm Hg
• Renal: serum creatinine > 2.0 mg %

Markers of Severity during Hospitalization:

• Persistent organ failure
• Pancreatic necrosis