Evaluation and management of acute pancreatitis

Table 2 Scoring systems for assessing severity of acute pancreatitis

Atlanta Revision (2013)	Ranson’s Criteria	BISAP
Mild acute	After 24 h of admission	Within 24 h of admission
(1) Absence of organ failure; (2) Absence of local complications	Age greater than 55; WBC > 16000; Blood Glucose > 200 mg/dL; Serum LD > 350 IU/L; Serum AST > 250/L	(1) BUN > 25 mg/dL; (2) Impaired mental status; (3) Systemic inflammatory response syndrome (SIRS); (4) Age > 60; (5) Presence of a pleural effusion
Moderately severe	After 48 h of admission
(1) Local complicationsa and/or (2) transient organ failureb for less than 48 h	Fall in Hematocrit > 10%; Fluid Sequestration > 6L; Hypocalcemia < 8 mg/dL; Hypoxemia; Increase in BUN of > 5 mg/dL after IV fluid; Base deficit of > 4 mmol/L
Severe	Mortality based on score	Mortality based on score
Persistent organ failure for greater than 48 h	Score of 0 to 2: 0%-3%; Score of 3 to 5: 11%-15%; Score of 6 to 11: 40%	Score of 0: 0.1%-0.2%; Score of 1: 0.5%-0.7%; Score of 2: 1.9%-2.1%; Score of 3: 5.3%-8.3%; Score of 4: 12.7%-19.3%; Score of 5: 22.5%-26.7%

^aLocal Complications: Interstitial edematous pancreatitis, necrotizing pancreatitis, pancreatic pseudocyst, acute necrotic collection, walled off necrosis, and pleural effusion. ^bOrgan Failure: Failure of main organ systems - respiratory, cardiac, renal, hepatic, hematological, neurological. WBC: White blood cells; LD: Lactate dehydrogenase; AST: Aspartate aminotransferase; BUN: Blood urea nitrogen; BISAP: Bedside Index of Severity in Acute Pancreatitis.