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World J Gastroenterol. Sep 21, 2013; 19(35): 5798-5805
Published online Sep 21, 2013. doi: 10.3748/wjg.v19.i35.5798
Criteria for the diagnosis and severity stratification of acute pancreatitis
Makoto Otsuki, Kazunori Takeda, Seiki Matsuno, Yasuyuki Kihara, Masaru Koizumi, Masahiko Hirota, Tetsuhide Ito, Keisho Kataoka, Motoji Kitagawa, Kazuo Inui, Yoshifumi Takeyama
Makoto Otsuki, Kitasuma Hospital, Kobe 654-0102, Japan
Makoto Otsuki, Yasuyuki Kihara, University of Occupational and Environmental Health, Japan, School of Medicine, Kitakyuushu, 807-8555, Japan
Kazunori Takeda, Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai 983-8520, Japan
Seiki Matsuno, Towada Shiritsu Central Hospital, Towada, Aomori 034-0093, Japan
Yasuyuki Kihara, Department of Gastroenterology, Kitakyushu Central Hospital, Kitakyushu, Fikuoka 800-0257, Japan
Masaru Koizumi, Kurihara Central Hospital, Kurihara, Miyagi 987-2203, Japan
Masahiko Hirota, Kumamoto Regional Medical Center, Health Care Center, Kumamoto, Kumamoto 860-0811, Japan
Tetsuhide Ito, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Keisho Kataoka, Otsu Municipal Hospital, Otsu, Shiga 520-0804, Japan
Motoji Kitagawa, Department of Nutritional Science, Nagoya University of Arts and Sciences, Nissin, Aichi 470-0196, Japan
Kazuo Inui, Department of Internal Medicine, Second Teaching Hospital, Fujita Health University School of Medicine, Nagoya 454-8509, Japan
Yoshifumi Takeyama, Department of Surgery, Kinki University School of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
Author contributions: Otsuki M, Takeda K, Matsuno S, Kihara Y, Koizumi M, Hirota M, Ito T, Kataoka K, Kitagawa M, Inui K and Takeyama Y designed the study, and collected, analyzed and interpreted the clinical data; Otsuki M wrote the manuscript.
Supported by A Grant-in-Aid to the Research Committee on Intractable Pancreatic Diseases provided from the Ministry of Health, Labour and Welfare of Japan
Correspondence to: Makoto Otsuki, MD, PhD, Kitasuma Hospital, 1-1-1 Higashi-Shirakawa dai, Suma, Kobe, Hyogo 654-0102, Japan. mac.otsk@gmail.com
Telephone: +81-78-7436666 Fax: +81-78-7431230
Received: January 7, 2013
Revised: June 14, 2013
Accepted: June 18, 2013
Published online: September 21, 2013
Processing time: 256 Days and 19.5 Hours
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.

Keywords: Severe acute pancreatitis; Severity score; Scoring system; Prognostic factors; Case-mortality

Core tip: The new severity criteria of acute pancreatitis (AP) consist of two independent prognostic factors; laboratory and/or clinical severity scores and contrast-enhanced computed tomography (CE-CT) findings. Mortality rate of severe acute pancreatitis (SAP) that satisfied both laboratory/clinical and CE-CT severity criteria was as high as 30.8%. It is recommended to perform CE-CT examination in those patients who were diagnosed as SAP by laboratory/clinical severity criteria. Patients who fulfill both severity criteria should be transferred to advanced medical units. The revised criteria are extremely useful to detect SAP at an early stage of AP.