Severe acute pancreatitis

Abstract

The patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Often, there is no correlation between the degree of structural damage to pancreas and clinical manifestation of the disease. The effectiveness of any treatment is related to the ability to predict severity accurately, but there is no ideal predictive system or biochemical marker. Severity assessment is indispensable to the selection of proper initial treatment in the management of acute pancreatitis. The use of multiparametric criteria and the evaluation of severity index permit us to select high-risk patients. Furthermore, contrast-enhanced computed tomographic scanning and contrast-enhanced MRI play an important role in severity assessment. The adoption of multiparametric criteria proposed together with morphological evaluation consents the formulation of a discreetly reliable prognosis on the evolution of the disease a few days from onset.

Analysis of the Power of Common Diagnostic Tools in the Management of Acute Pancreatitis

“…Looking at the value of CE-CT in predicting SAP and mortality, it does not exceed the power of several clinical scoring systems used on predicting the severity of acute pancreatitis [8]. Up to now the Acute Physiology and Chronic Health Evaluation (APACHE) II-score has been considered the most reliable system [9]. A score higher than 8 is associated with a severe course with higher mortality, although predictive values show the limitations for this complex scoring system [3].…”

Serum levels of thyroid hormones and thyroid stimulating hormone in patients with biliogenic and hyperlipidaemic acute pancreatitis: Difference and value in predicting disease severity

“… 8 – 10 Since AP of different aetiologies and severity may have different clinical outcomes and require different treatment, assessing disease severity is essential for selection of the most appropriate initial treatment. 11 …”

A reduced lymphocyte ratio as an early marker for predicting acute pancreatitis

“…AP is associated with the development of SAP in up to 20% of patients. The mortality rate could increase to 20–50% if the best treatment opportunities are missed because of the lack of early diagnosis and severity grading18. In the past, only 19% of patients with AP were accurately graded, and only 67% of patients diagnosed with SAP received timely treatment in the ICU19.…”