title: Predictors of severe and critical acute pancreatitis: a systematic review.
abstract: BACKGROUND
  Persistent organ failure and infected pancreatic necrosis are major determinants of mortality in acute pancreatitis, but there is a gap in the literature assessing the best available predictors of these two determinants. The purpose of this review was to investigate the utility of predictors of persistent organ failure and infected pancreatic necrosis in patients with acute pancreatitis, both alone and in combination.
  
  
  METHODS
  We performed a systematic search of the literature in 3 databases for prospective studies evaluating predictors of persistent organ failure, infected pancreatic necrosis, or both, with strict eligibility criteria.
  
  
  RESULTS
  The best predictors of persistent organ failure were the Japanese Severity Score and Bedside Index of Severity in Acute Pancreatitis when the evaluation was performed within 48h of admission, and blood urea nitrogen and Japanese Severity Score after 48h of admission. Systemic Inflammation Response Syndrome was a poor predictor of persistent organ failure. The best predictor of infected pancreatic necrosis was procalcitonin.
  
  
  CONCLUSIONS
  Based on the best available data, it is justifiable to use blood urea nitrogen for prediction of persistent organ failure after 48h of admission and procalcitonin for prediction of infected pancreatic necrosis in patients with confirmed pancreatic necrosis. There is no predictor of persistent organ failure that can be justifiably used in clinical practice within 48h of admission.
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Yang
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Anthony R J
authors.initials: AR
authors.lastname: Phillips
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand. Electronic address: max.petrov@gmail.com.
authors.forename: Maxim S
authors.initials: MS
authors.lastname: Petrov
mesh_terms: D000208:Acute Disease; D001806:Blood Urea Nitrogen; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide; D016638:Critical Illness; D018450:Disease Progression; D006801:Humans; D009102:Multiple Organ Failure; D009336:Necrosis; D010179:Pancreas / Q000473:pathology*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications*; D011237:Predictive Value of Tests; D011498:Protein Precursors; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: Acute pancreatitis; Infected pancreatic necrosis; Persistent organ failure; Prediction; Severity