title: Criteria for the diagnosis and severity stratification of acute pancreatitis.
abstract: Recent diagnostic and therapeutic progress for severe acute pancreatitis (SAP) remarkably decreased the case-mortality rate. To further decrease the mortality rate of SAP, it is important to precisely evaluate the severity at an early stage, and initiate appropriate treatment as early as possible. Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs. Severity can be evaluated by laboratory examinations or by clinical signs, reducing the defect values of the severity factors. Moreover, the severity criteria considered laboratory/clinical severity scores and contrast-enhanced computed tomography (CE-CT) findings as independent risk factors. Thus, CE-CT scans are not necessarily required to evaluate the severity of acute pancreatitis. There was no fatal case in mild AP diagnosed by the CE-CT severity score, whereas case-mortality rate in those with SAP was 14.8%. Case-mortality of SAP that fulfilled both the laboratory/clinical and the CE-CT severity criteria was 30.8%. It is recommended, therefore, to perform CE-CT examination to clarify the prognosis in those patients who were diagnosed as SAP by laboratory/clinical severity criteria. Because the mortality rate of these patients with SAP is high, such patients should be transferred to advanced medical units.
authors.affiliation: Makoto Otsuki, Kitasuma Hospital, Kobe 654-0102, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Otsuki
authors.forename: Kazunori
authors.initials: K
authors.lastname: Takeda
authors.forename: Seiki
authors.initials: S
authors.lastname: Matsuno
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kihara
authors.forename: Masaru
authors.initials: M
authors.lastname: Koizumi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
authors.forename: Tetsuhide
authors.initials: T
authors.lastname: Ito
authors.forename: Keisho
authors.initials: K
authors.lastname: Kataoka
authors.forename: Motoji
authors.initials: M
authors.lastname: Kitagawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Inui
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Takeyama
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media; D003661:Decision Support Techniques; D006801:Humans; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D003287:Contrast Media
keywords: Case-mortality; Prognostic factors; Scoring system; Severe acute pancreatitis; Severity score