Acute Pancreatitis Lacks Ideal Prediction Tool

Though most patients who present with acute pancreatitis have mild disease and uneventfully recover, some cases are plagued with complications that make pancreatitis one of the most difficult conditions for surgeons to diagnose. All of the available pancreatitis scoring systems define severe disease as an episode accompanied by disease-specific complications and increased risk of mortality; however, each individual’s course is unique.

Some scoring systems are only useful at the time of patient presentation, while others use biochemical markers or multi-parameter scoring. To guide early and reliable disease severity stratification, the August 2013 issue of Langenbecks Archives of Surgery included a concise review of various scoring systems.

In that review, the authors’ bottom-line recommendation is to assess the patient’s hematocrit upon admission, calculate sequential organ failure assessment score and procalcitonin levels each day, evaluate C-reactive protein on the third day, and determine CT severity index beyond the first week. The researchers said employing those tools with close clinical follow-up is optimal, since objective quantification helps surgeons select the best treatments, prepare for possible complications, and appropriately refer the most fragile cases to specialist centers.

Scoring systems have understandably evolved as technology has advanced. All of the systems include the basic tools that surgeons have relied on for decades, such as the patient’s medical history, laboratory values, diagnostic imaging, and clinical signs and symptoms. However, scoring system modifications have followed research findings identifying new risk factors or associations. For example, advanced age, fever, shock, respiratory failure, anuria, neurologic disturbance, and ileus — as well as palpable abdominal mass, abdominal wall bruising, and most recently, abdominal compartment syndrome — are now risks factor for pancreatitis complications and morbidity.

Even though they reviewed dozens of scoring tools, the researchers concluded that surgeons still don’t have an ideal tool to predict severity in early acute pancreatitis. They also indicated that no single scoring system covers the entire range of problems with assessing acute pancreatitis.

Nevertheless, this review is useful for surgeons who regularly use a particular scoring system, yet would like to assess its comparative value. It’s also valuable for surgeons who are interested in taking new or different approaches to acute pancreatitis assessment.