Clinical Value of Severity Markers in Acute Pancreatitis

Abstract

Acute pancreatitis is a common digestive disease of which the severity may vary from mild, edematous to severe, necrotizing disease. An improved outcome in the severe form of the disease is based on early identification of disease severity and subsequent focused management of these high-risk patients. However, the ability of clinicians to predict, upon presentation, which patient will have mild or severe acute pancreatitis is not accurate. Prospective systems using clinical criteria have been used to determine severity in patients with acute pancreatitis, such as the Ranson's prognostic signs, Glasgow score, and the acute physiology and chronic health evaluation II score (APACHE II). Their application in clinical practise has been limited by the time delay of at least 48 h to judge all parameters in the former two and by being cumbersome and time-consuming in the latter. Contrast-enhanced computed tomography is presently the most accurate non-invasive single method to evaluate the severity of acute pancreatitis. It cannot, however, be performed to all patients with acute pancreatitis. Therefore, considerable interest has grown in the development of reliable biochemical markers that reflect the severity of acute pancreatitis. In this article we critically appraise current and new severity markers of acute pancreatitis in their ability to distinguish between mild and severe disease and their clinical utility.

Severe Acute Pancreatitis Requiring Drainage Therapy: Findings on Computed Tomography as Predictor of Patient Outcome

“…Severe acute pancreatitis (SAP) with necrosis of the pancreatic or peripancreatic tissue exhibits two phases [1]: In the first phase, pancreatic inflammation and necrosis are associated with systemic inflammatory response syndrome that may lead to multiple organ failure. The second phase usually beginning in the third week after symptom onset is dominated by infection of the necrotic tissue with possible progression to overt sepsis and septic multiple organ failure [2].…”

“…The improved outcome is based on early identification of patients at risk and subsequent aggressive patient monitoring and treatment [1]. Hence, rapid and reliable assessment of prognosis is essential, which includes (1) stratification of patients with AP to identify those with edematous versus those with evidence of or predicted SAP (early risk stratification), and (2) further stratification of patients with SAP into a low- and high-risk group (delayed risk stratification of patients with SAP).…”

Cancer Risk among the Relatives of Patients with Pancreatic Ductal Adenocarcinoma

“…The search for a tool that would improve clinical assessment has been going on for decades. Several biochemical parameters [10][11][12] , instrumental methods [13,14] , machine-learning techniques [15,16] , and multiple clinicobiochemical scores [17,18] have been used to assess the severity of AP. An ideal prognostic method should be easily applicable, relatively simple, inexpensive, and highly accurate in the early phase of the disease [19] .…”

Does Elevated Serum Levels of Procalcitonin Potentially Correlate with Severity of Acute Pancreatitis: A Prospective Study

“…The scoring systems of patients with AP helps in many ways, clinicians are aware of potential severity of disease and can be used comparison tool to assess effectiveness of new treatment within and between patient series. Sadly, at the moment the scoring systems are often insufficient to predict severity and recognize early organ failure [16][17][18]. Therefore, a reliable scoring system or single biomarkers that adequately characterize the severity of AP is warranted.…”