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Mahajan, Ojas, Satish Mahajan, Kashish Khurana, Sarang Raut, and Nikhil Pantbalekundri. "Ranson Criteria – Old is Gold in Evaluating Acute Pancreatitis?" Journal of Datta Meghe Institute of Medical Sciences University 19, no. 2 (2024): 219–23. http://dx.doi.org/10.4103/jdmimsu.jdmimsu_584_22.
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Abstract Acute pancreatitis (AP) is a communal gastrointestinal condition that can vary in severity and morbidity. The “Ranson Score,” which was created in 1974, was the 1st scoring scheme to predict the cruelty of AP. While the “Ranson Score” has remained popular for decades, it is to have some flaws, such as limited predictive power. It has also been chastised for requiring 48 h to compute the concluding score, which has been found to cause administration delays. Using the electronic databases Medline, PubMed, Embase, and Google, a literature search in English was carried out. The exploration terms were Ranson Criteria OR “Ranson Score” OR AP OR Diagnostic Criteria. Researchers concluded that the “Ranson Score” is comparable to other recent counting systems for classifying AP severity and predicting death, making it a valuable tool for prognosticating AP in contemporary clinical practice. The studies also demonstrated that there is no one best grading system for predicting mortality and severity in AP patients. There are advantages and disadvantages to using each measure, and variations in research outcomes may be attributed to changes in people’s characteristics, AP etiology, and clinical care heterogeneity. The “Ranson Score,” despite being the ancient scoring system known, has preserved its clinical validity over time. These features, combined with its comparative easiness of use and applicability in reserve/constrained situations, make the “Ranson Score” an important and useful instrument in present clinical practice.
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Hernando, Enrique Thorné Vélez, Eduardo Pérez Rojas Luis, María Thorné Vélez Ana, et al. "Ranson criteria for the diagnosis of acute pancreatitis, useful or in disuse?" World Journal of Advanced Research and Reviews 14, no. 2 (2022): 240–45. https://doi.org/10.5281/zenodo.7297887.
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Acute pancreatitis is one of the high-mortality gastrointestinal disorders that requires hospitalization, in this pathology there are various degrees of severity, and it is important to define and stratify them to identify dangerous patients who require aggressive treatment on admission, to identify patients worthy of referral for specialized care and to assign these patients to stratification into subgroups with persistent organ failure and local or systemic complications, the use of scales and criteria is implemented to determine the degree of severity of this and the possible management, among them we find the Ranson criteria, which contribute to the determination of severity, conduct to follow and possible complications, which is usually very useful for the patient's prognosis, but although it is true, the Ranson criteria are simple, easy to remember and very available in any laboratory to carry out ar tests, but they are also limited since they present greater specificity after the first 48 hours of the patient's admission and, in addition, they can be inconclusive because they vary according to the presence or not of a biliary pathology, thus increasing the parameters to be evaluated.
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Uslu, Muhammed Fuad, Esra Timurkaan, Mustafa Timurkaan, and Mustafa Yılmaz. "Inflammatory indices as an indicator of acute pancreatitis severity." Interdisciplinary Medical Journal 16, no. 54 (2025): 38–44. https://doi.org/10.17944/interdiscip.1503687.
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Objective: The present study aimed to compare C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), neutrophil/albumin ratio (NAR), platelet/leukocyte ratio (PLR), systemic immune inflammation (SII), systemic inflammation response index (SIRI) and Ranson criteria associated with inflammation in acute pancreatitis (AP). Thus, the study aimed to analyze the significance ranking of these parameters in terms of disease severity. Method: The present retrospective study was conducted after the ethics committee approval was obtained. The study included 221 AP patients visited hospital between 01.01.2018 and 31.12.2023. The patients were categorized into two groups based on Ranson criteria: Group 1 (Ranson≤2, n=147) and Group 2 (Ranson≥3, n=74). Basic participant demographics, laboratory reports, CRP, NLR, NAR, PLR, SII, SIRI and hospitalization periods were recorded in a data form, and the findings were analyzed. Results: There was no difference between the groups based on gender (p=0.094). The Group 2 patients were older (p<0.001) than the ones in Group 1. Furthermore, CRP (p=0.001), NLR (p<0.001), NAR (p<0.001), PLR (p<0.001), SII (p<0.001) and SIRI (p<0.001) were higher in Group 2 patients when compared to Group 1. Also, the hospitalization period was significantly longer in Group 2 (p<0.001) compared to Group 1. Conclusion: In the study, it was determined that the CRP, NAR, PLR, NLR, SII and SIRI findings were significantly higher in AP patients with a Ranson criteria ≥ 3, and a positive correlation was found between Ranson criteria and inflammatory parameters.
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N, Durga Prasad, and Ramarao Kamadi. "A Study to Predict Severe Acute Pancreatitis Using Ransons Score from a Tertiary Health Care Setup." International Journal of Toxicological and Pharmacological Research 13, no. 3 (2023): 399–401. https://doi.org/10.5281/zenodo.11264850.
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<strong>Introduction:</strong> Severe acute pancreatitis (SAP) presents a significant medical challenge, necessitating accurate severity assessment. Ranson’s Criteria, a widely adopted scoring system, aids in prognosis prediction. However, its limitations prompt ongoing refinement efforts. This study investigates Ranson’s score’s diagnostic utility in SAP, addressing its relevance and potential enhancements. <strong>Methods:</strong> This study was conducted in department of General Surgery, government medical College, Eluru. included patients >18 years with acute pancreatitis, excluding those with pancreatic malignancies, undergoing treatment, pregnant, or uncooperative. Demographic, clinical, and biochemical data were collected at baseline and 48 hours. Ranson’s and BISAP scores were compared with the revised Atlanta classification for severity assessment. <strong>Results: </strong>Out of 140 participants, 34 were diagnosed with acute pancreatitis (AP), with a higher prevalence in the 28–37 age group (39%; 13) followed by 48–57 (29.4%; 10). BISAP score ≥3 correlated with increased severity, organ failure, necrosis, and mortality, surpassing Ranson’s score in predicting severe acute pancreatitis. <strong>Conclusion:</strong> SAP poses a significant health threat with notable mortality rates. Alcohol remains a predominant risk factor, particularly among younger individuals. BISAP score ≥3 signifies increased severity and mortality, surpassing Ranson’s score in prognostic accuracy, highlighting its crucial role in acute pancreatitis management.
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Vijay, Kumar Shah1 Subodh Gautam2 Saharoj Siddiqui3 Ashmita Nepal4 Dipesh Kumar Gupta5. "BISAP Score as a Superior Predictor for Severe Acute Pancreatitis Compared to Ranson's Criteria: A cross sectional study." International Journal of Medical Science in Clinical Research and Review 7, no. 05 (2024): 1112–20. https://doi.org/10.5281/zenodo.13998231.
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<strong><u>ABSTRACT</u></strong><strong>:</strong> <strong>Background</strong>: Acute pancreatitis (AP) is an inflammatory condition of the pancreas characterized by activation of pancreatic enzymes to cause self-digestion of the pancreas, which presents as a mild upper abdominal discomfort with local inflammation to severe disease with multi-organ failure. It has a mortality of approximately 1% among all AP but it might be as high as 20% to 30% among those with severe acute pancreatitis (SAP). In clinical practice, accurate classification of the severity of acute pancreatitis is valuable in reducing mortality by clinical decision-making and action. The aim of this study is to compare the accuracy of BISAP scoring system and Ranson scoring system in predicting severity of acute pancreatitis. <strong>Methods: </strong>This is an observational, cross-sectional study conducted using a non-probability purposive sampling method. Result: A total of 25 patients with first episode of Acute Pancreatitis admitted were evaluated. <strong>Result</strong>: BISAP score of less than or equal to 3 predicted 93.75% of severe attacks and 83.3% of mild attacks with a PPV of 93.75% and NPV of 83.3% and accuracy of 90.09%. Ranson’s score of greater than or equal to 4 predicted 42.8 % of severe attacks and 75 % of mild attacks with a positive predictive value of 33.33% and negative predictive value of 75% and accuracy of 60%. BISAP score has a better sensitivity, specificity, PPV, NPV and Accuracy than Ranson score in predicting the severity of AP putting the cutoff score >3 for both the scoring systems. <strong>Conclusion:</strong> BISAP scoring system is very simple, cheap, easy to remember and calculate. It is instantaneous and there is no time delay in contrast to Ranson’s score. It is also found to be superior to RANSON’s score in predicting severity. <strong> </strong> <strong><em>Keywords: Acute Pancreatitis, Accuracy, BISAP score, Ranson Score, Severity</em></strong>
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Hernando Enrique Thorné Vélez, Luis Eduardo Pérez Rojas, Ana María Thorné Vélez, et al. "Ranson criteria for the diagnosis of acute pancreatitis, useful or in disuse?" World Journal of Advanced Research and Reviews 14, no. 2 (2022): 240–45. http://dx.doi.org/10.30574/wjarr.2022.14.2.0365.
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Acute pancreatitis is one of the high-mortality gastrointestinal disorders that requires hospitalization, in this pathology there are various degrees of severity, and it is important to define and stratify them to identify dangerous patients who require aggressive treatment on admission, to identify patients worthy of referral for specialized care and to assign these patients to stratification into subgroups with persistent organ failure and local or systemic complications, the use of scales and criteria is implemented to determine the degree of severity of this and the possible management, among them we find the Ranson criteria, which contribute to the determination of severity, conduct to follow and possible complications, which is usually very useful for the patient's prognosis, but although it is true, the Ranson criteria are simple, easy to remember and very available in any laboratory to carry out ar tests, but they are also limited since they present greater specificity after the first 48 hours of the patient's admission and, in addition, they can be inconclusive because they vary according to the presence or not of a biliary pathology, thus increasing the parameters to be evaluated.
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Bulur, Atilla, and Pembegül Yumuştutan. "Disease severity and prognostic nutritional index (PNI), C-reactive protein (CRP), and red blood cell distribution width (RDW) in acute pancreatitis." Medical Science and Discovery 10, no. 2 (2023): 81–86. http://dx.doi.org/10.36472/msd.v10i2.875.
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Objective: Acute pancreatitis is a common emergency. Morbidity control requires early detection of disease severity. Material and Methods: A total of 131 AP patients were analyzed retrospectively. Patients were divided into two groups mild AP (MAP: Ranson score <3) and severe AP (SAP: Ranson score ≥3), according to Ranson’s criteria. Demographic data, hospitalization duration, PNI, CRP, and RDW levels were compared. Any p-value below 0.05 (p<0.05) was accepted as statistically significant. Results: Study included 67 (51.15%) males and 64 (48.85%) females. The age average was 59.74 (19-90) years. 95 (72.52%) patients had MAP, and 36 (27.48%) patients had SAP. Mean hospitalization time, PNI, and CRP differed significantly between the two groups (p=0.010, p<0.05, p<0.05, respectively). The RDW (p=0.380) level difference was insignificant. For SAP prediction; the sensitivity, specificity, and cut-off value according to Ranson code cut-off point for PNI were determined as 80.0% (95% CI:54.8-85.8), %72.2 (95% CI:70.5-87.5) and ≤45.6 (gr/L) + (mm3), respectively, and 94.7% (95% CI:57.8-87.9), %75.0 (95% CI:88.1-98.3) and >105,1 mg/L, respectively for CRP. Conclusion: PNI and CRP values (but not RDW values) were compatible with the disease severity determined by the Ranson criteria.
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Rehan Khan, Muhammad, Tayyaba Mushtaq Khan, Syed Munim Hussain, and Syed Mukarram Hussain. "Accuracy of Bisap Score to Predict Severe Acute Pancreatitis Keeping Ranson Score as Gold Standard." Pakistan Journal of Medical and Health Sciences 15, no. 10 (2021): 3426–28. http://dx.doi.org/10.53350/pjmhs2115103426.
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Objective: To ascertain the diagnostic accuracy of BISAP score to predict severe acute pancreatitis keeping Ranson score as gold standard Study design: Descriptive Cross Sectional study Place and duration of study: Surgical Department, Combined Military Hospital Rawalpindi from January 2017 to July 2017. Methodology: 65 patients having history indicative of acute pancreatitis, serum lipase and serum amylase were measured. Patients with confirmed diagnosis of acute pancreatitis who consented for taking part in the research and achieving the inclusion and exclusion criteria were enrolled for study. Patients were evaluated by adequate history and thorough examination. All patients are investigated for Ranson score and BISAP score and divided into mild and severe pancreatitis on the basis of BISAPS and Ranson scoring. Results: In our study, mean+sd age was 44.92+8.92 years. Frequency of severe acute pancreatitis was 32.3%. Diagnostic accuracy of BISAP score to predict severe acute pancreatitis keeping Ranson score as gold standard had 80.9% of sensitivity, 81% of specificity, 68% of PPV and 90% of NPV. Conclusion: BISAP score have an excellent accuracy for prediction of severe acute pancreatitis as Ranson score. BISAP score can be used as tool for recognition of severe acute pancreatitis within 24 hours in simple and precise manner. Keywords: Severe acute pancreatitis, Prediction, BISAP score, Ranson score, Accuracy
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Bollamreddy, Lokesh, H. K. Tulasi Mohana Rao Ch, Nekkanty Ravi, S. Balagangadhara Rao M, Ranjan Nayak Samir, and Jaya Chandra T. "Study on Comparison between BISAP and Ransons Scores for Predicting Severe Acute Pancreatitis." International Journal of Toxicological and Pharmacological Research 14, no. 5 (2024): 131–33. https://doi.org/10.5281/zenodo.12787614.
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<strong>Introduction: </strong>Severe acute pancreatitis (SAP) requires accurate severity prediction. Studies show mixed results on BISAP and Ranson’s scores. While some favor BISAP’s early prediction, others find comparable accuracy. The debate continues, balancing BISAP’s simplicity with Ranson’s comprehensiveness. Future research aims to refine scoring systems and incorporate advanced diagnostic tools. <strong>Methods: </strong>Demographic, clinical, and biochemical data were collected at baseline and 48 hours post-admission. Ranson’s and BISAP scores were assigned to each patient and compared with the revised Atlanta classification for acute pancreatitis (AP). Parameters evaluated included age, gender, etiology, and various biochemical markers, among others, with data tabulated and graphically presented. <strong>Results: </strong>Among 101 patients, BISAP scores distribution was: 5.94% scored 0, 24.75% scored 1, 34.65% scored 2, 18.81% scored 3, 10.89% scored 4, and 4.95% scored 5; mean score was 2.18±1.23. SAP was observed in 27.72% of patients, with 6.93% mortality. Ranson’s score ≥3 was in 36% of patients. BISAP score demonstrated higher predictive ability for SAP (OR=2.67, P=0.0003) than Ranson’s (OR=1.47). <strong>Conclusion: </strong>Our study provides evidence supporting the superior predictive capability of the BISAP score compared to Ranson’s criteria in identifying SAP cases. Early risk stratification using the BISAP score can aid clinicians in optimizing patient management and improving outcomes in AP.
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Dr, Dileep C. "A Comparison of Clinical Findings and CT Severity Index in Acute Pancreatitis." International Journal of Medical and Pharmaceutical Research 4, no. 4 (2023): 44–50. https://doi.org/10.5281/zenodo.8166306.
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<strong>Background:</strong> Acute pancreatitis is a severe inflammatory condition with a varied clinical course. Early prediction of disease severity is crucial to guide management and improve outcomes. This study aimed to compare the predictive accuracy of Ranson's criteria and Mortele’s modified CT severity index (MDCTSI) in assessing the severity and prognosis of acute pancreatitis. <strong>Methods:</strong> A retrospective study was conducted on 120 patients with acute pancreatitis admitted to the Department of General Surgery in hospitals associated to Bangalore Medical College and Research Institute from September 2021 to August 2022. Patients were evaluated based on clinical findings, laboratory results, and CT scans. Outcomes were assessed using Ranson's score and MDCTSI. <strong>Results</strong>: Both scoring systems accurately predicted the severity of the disease, complications, and mortality. All deaths occurred in patients with a Ranson's score and MDCTSI of >3 and >6, respectively. Patients with a Ranson’s score of >3 and MDCTSI of >6 had a higher rate of complications (59% and 71%, respectively) and ICU admission (100% and 80%, respectively). <strong>Conclusion</strong>: Ranson's scoring system and Mortele’s MDCTSI are effective tools in predicting the clinical course, complications, and mortality in acute pancreatitis. These findings underline the utility of these scoring systems in facilitating patient management and potentially reducing morbidity and mortality.
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Mahajan, Ojas, Satish Mahajan, Sourya Acharya, et al. "A comparative evaluation of different scores in predicting severity and outcome in acute pancreatitis." F1000Research 12 (July 13, 2023): 824. http://dx.doi.org/10.12688/f1000research.133278.1.
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Background: Acute pancreatitis (AP) is an inflammatory condition usually caused by alcohol or gallstones. Our goal was to prospectively compare the diagnostic efficacy of the Acute Physiology & Chronic Health Evaluation (APACHE) II, the Bedside Index of Severity in Acute Pancreatitis (BISAP), the Ranson's score & the Modified Glasgow Score (MGS) in determining the severity & outcome of Acute pancreatitis in a tertiary care facility in central India. Methods: Between December 2020 & December 2022, this prospective observational study was done in rural area of Wardha district. 110 subjects were included, and the diagnosis of acute pancreatitis was done using Atlanta criteria. APACHE II, MGS, Ranson score on admission, Ranson score 48 hours after admission & BISAP were used to evaluate each subject. The reciever operating curve was used to measure the specificity, sensitivity, NPV, PPV, diagnostic accuracy, area under the curve (AUC) & these scoring methods were then prospectively compared. Results: When a cut-off based on the literature was used, the APACHE II score could accurately diagnose severe cases of AP (n=110) in 69 patients, BISAP in 68 patients, MGS in 49, Ranson score on admission in 48 patients & after 48 hours in 48 patients. This study showed that Ranson score 48 hours after admission had a AUC (0.991), Ranson score at admission (AUC 0.989) & Modified Glasgow Scale (AUC 0.6486) had fair accuracy as compared to APACHE II (AUC 0.974) & BISAP (AUC 0.896) for determining the level of severity among AP patients based on ROC curves. Conclusion: To predict the severity of AP, the Ranson score after 48 hours showed the highest NPV, PPV, sensitivity, specificity, and diagnostic accuracy of all the scoring methods tested. The BISAP score had the highest specificity, sensitivity, PPV& NPV for determining the outcome of AP.
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BAŞKOCAGİL, Ersin, Meltem GÜMÜŞ, Alaaddin YORULMAZ, and Halil Haldun EMİROĞLU. "Akut pankreatitli çocuklarda klinik özellikler, tanı, tedavi ve komplikasyonlar yönünden retrospektif analiz: tek merkez sonuçları." Journal of Medicine and Palliative Care 4, no. 5 (2023): 456–65. http://dx.doi.org/10.47582/jompac.1341423.
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Aim: In the present study, the purpose was to evaluate the demographic and clinical data of pediatric patients, who had pancreatitis, who were followed up as outpatients or in the wards, and to evaluate the treatment modalities used along with nutritional status, length of hospital stays, and complications.
 Methods: This study was carried out by retrospectively evaluating the files of 166 patients identified by INSPPIRE Criteria who were followed up at the Department of Pediatric Gastroenterology, Faculty of Medicine, at xx University between 2011 and 2021. The age, gender, height, weight, known disease, drugs used, follow-up periods by us, complaints on admission, the etiological reason for the diagnosis, type of pancreatitis, length of hospital stay, treatment modalities applied, and complications of the patients were recorded. The PAPPS Scores, Ranson Admission Scores, and Ranson 48th hour Scores of the patients were analyzed.
 Results: A total of 120 patients (72.3%) had AP, 25 patients (15.1%) had CP, and 21 patient (12.7%) had ARP. According to the Atlanta Criteria, 82.5% were mild and 17.5% were moderate. The most common complaint was abdominal pain and the most common cause was found to be idiopathic. There was a weak and positive correlation between the PAPPS Score, Ranson Admission Score, and length of hospital stay.
 Conclusion: In the diagnosis and follow-up of pancreatitis, it is important to determine the severity of the disease and to reveal the etiology. Establishing and applying standard approaches for early diagnosis and treatment of patients will lead to prognostic improvement and prevent related complications.
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Dr., Velmurugan S., (Prof.) T.R. Khurana Dr., and (Prof.) Shibani Mehra Dr. "Evaluation of the severity of acute pancreatitis using BISAP, Ranson and APACHE II scores and comparing them with Modified Computed Tomography Severity Index score." International Multispeciality Journal of Health 7, no. 10 (2021): 07–13. https://doi.org/10.5281/zenodo.5624782.
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<strong>Abstract</strong><strong>—</strong> <strong>Aims and Objectives:</strong> Most of the studies published so far compare one or two out of the three clinical scores for assessing the severity of acute pancreatitis namely BISAP, Ranson and APACHE II scores with the Radiological Score of Modified Computed Tomography Severity Index. There is a paucity of studies that compare all three Clinical Scores with the Radiological Score of Modified Computed Tomography Severity Index. The aim of this study is to compare all three clinical scores with the radiological score mentioned above. <strong>Materials and Methods:</strong> This is a cross sectional study which was conducted in the Department of Medicine and Department of Radiology, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi. A total of 40 patients were studied from November 2018 to March 2020. Admitted patients who fit into the New Diagnostic Criteria of the Revised Atlanta Classification for acute pancreatitis were taken into the study after getting the informed consent signed. CECT abdomen was done during the hospital stay and modified CTSI score was calculated. Patients with BISAP score ≥ 3, Ranson score ≥ 3, APACHE II score ≥ 8 and modified CTSI ≥ 4 (4-6: moderately severe, 8-10: severe; Note that in modified CTSI score, the final scores are always in even number) were classified as severe acute pancreatitis. <strong>Results:</strong> The results of our study showed that the Modified CTSI score has the highest accuracy among the four scores in predicting severity of acute pancreatitis (AUC 0.969, P value <0.0001) which is statistically significant. Among the bedside scores namely APACHE II, Ranson and BISAP scores, the AUC was high in APACHE II score (AUC 0.750, P value 0.001) in comparison with Ranson score (AUC 0.688, P value <0.0001) and BISAP score (AUC 0.656, P value 0.0002). Click here to download full Paper
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Carioca, André Lanza, Debora Rodrigues Jozala, Lucas Oliveira de Bem, and Jose Mauro da Silva Rodrigues. "Severity assessment of acute pancreatitis: applying Marshall scoring system." Revista do Colégio Brasileiro de Cirurgiões 42, no. 5 (2015): 325–27. http://dx.doi.org/10.1590/0100-69912015005010.
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Objective: To analyze the effectiveness of the Marshall scoring system to evaluate the severity of acute pancreatitis (AP). Methods : We performed a prospective, observational study in 39 patients with AP evaluated by the Marshall scoring system and the Ranson criteria (admission and 48 hours). We assessed the progression of the disease for seven days and compared the data of the two criteria. Results : Seven patients died during the observation period and one died afterwards. All deaths had shown failure of at least one system by the Marshall method. Conclusion : The Marshall scoring system may be used as an effective and simplified application method to assess the severity of acute pancreatitis.
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ÖZÇAĞLAYAN, Ruhsen, and Attila ONMEZ. "Monosit-HDL-kolesterol akut pankreatitte hastalık şiddetinin belirleyicisi midir?" Journal of Medicine and Palliative Care 4, no. 3 (2023): 196–200. http://dx.doi.org/10.47582/jompac.1261852.
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Aims: Acute pancreatitis is an inflammatory process of the pancreas that can affect local tissues or distant organ systems. Recent studies have described the monocyte count to high density lipoprotein (HDL) cholesterol ratio (MHR) as a significant prognostic marker. The aim of this study was to investigate the relationship between the MHR and disease severity in patients diagnosed with AP.
 Methods: One hundred sixty-six AP patients were enrolled in this study. MHR and inflammatory parameters were measured for all study participants. Disease severity was measured using the Ranson score on admission, and cases were classified as mild or severe AP. MHR was then compared between the groups. 
 Results: MHR values were significantly higher in severe AP patients (25.2, range 7.89-77.8) compared with mild AP patients (14.32, range 0.71-80) (P=0.006). Based on the Ranson criteria, the overall accuracy of MHR in determining severe AP was sensitivity 72.7% and specificity 69% (AUC: 0.762; P=0.006). The overall accuracy of MHR in predicting disease severity was superior to other inflammatory markers.
 Conclusion: The study findings indicated that MHR values are significantly elevated and capable of use in determining disease severity in AP patients.
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Yaghoubian, Arezou, Armen Aboulian, Tony Chan, et al. "Use of Clinical Triage Criteria Decreases Monitored Care Bed Utilization in Gallstone Pancreatitis." American Surgeon 76, no. 10 (2010): 1147–49. http://dx.doi.org/10.1177/000313481007601029.
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Admission indicators for monitored care in gallstone pancreatitis have been lacking. Recently, we established three criteria for admission to intensive care unit or step down versus ward beds: 1) concomitant cholangitis, 2) heart rate > 110 beats/min, and 3) blood urea nitrogen > 15 mg/dL. The purpose of this study was to determine whether these criteria would be effective in decreasing monitored care bed utilization without adversely affecting outcomes. A retrospective review of all patients with gallstone pancreatitis at a public teaching hospital was performed (2003-2009). A comparison was made of patients before (2003-2005, Period 1) and after (2006-2009, Period 2) establishment of monitored care triage criteria. Over the study period, there were 379 patients. The median Ranson score for both periods was 1. The median ages were 41 and 39, ( P = 0.7). In Period 1, 28 per cent of patients were admitted to the intensive care unit/step down unit versus 12 per cent in Period 2. None of the patients required transfer from the ward to a monitored care setting in Period 2. There were no mortalities in either period. In conclusion, the presence of concomitant cholangitis, heart rate >110, and blood urea nitrogen > 15 are useful and safe triage criteria for admission to a monitored care setting. Use of these criteria significantly decreased monitored care bed utilization and resulted in fewer mis-triages without adversely affecting patient outcomes.
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Leung, Ting-Kai. "Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome." World Journal of Gastroenterology 11, no. 38 (2005): 6049. http://dx.doi.org/10.3748/wjg.v11.i38.6049.
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Bereanu, Alina Simona, Bogdan Vintilă, and Mihai Sava. "Intra-Abdominal Pressure, a Prognostic Marker in the Evolution of Acute Pancreatitis." Acta Medica Transilvanica 24, no. 4 (2019): 51–55. http://dx.doi.org/10.2478/amtsb-2019-0016.
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Abstract In acute pancreatitis some prognostic scores have been suggested, based on clinical, laboratory and radiological criteria. The most popular are: Ranson score, APACHE II score and CT severity index (CTSI). The trend is to find a prognostic marker that is easy to use, cheap, and reproductible. Recently, the increase of the intra-abdominal pressure (IAP) has drawn attention. Material and Methods: From January 2012 to April 2014, a group of 64 patients, admitted to the Clinical Department of Anaesthesia and Intensive Care and the Surgical Departments of the SCJU Sibiu, with the diagnosis of acute pancreatitis, were included in this observational prospective study. The cut-off values, the specificity and sensitivity of the prognostic scores were calculated using the receiver operating characteristics (ROC) analysis curves. Results: At a cut-off value of 12 mm Hg IAP max has a sensitivity of 0,75, similar to Ranson score at 48 h (0.72 at a cut-off value 3) and CTSI (0,73 at a cut-off value 4). Better results are just for APACHE II score at 24 h (0,88 at a cut-off value 8). IAP max has a specificity of 0,88, simillary to CTSI (0,83) and APACHE II score (0,82). Conclusions: In our study maximum IAP could be correlated with prognostic markers for severe evolution in acute pancreatitis.
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Dr., Sara Mustafa Dr. Maryam Saber Dr. Hamna Zeb. "ANALYSIS OF RANSON SCORE VS SERUM PROCALCITONIN FOR PREDICTING THE SEVERITY OF ACUTE PANCREATITIS: A POPULATION BASED STUDY." INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES 05, no. 12 (2018): 16705–8. https://doi.org/10.5281/zenodo.2482851.
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<strong><em>Introduction: </em></strong><em>Acute pancreatitis (AP) is highly variable in terms of its clinical presentation and severity. Many scoring systems have been developed for the early detection of severe AP, but they are not convenient for predicting the severity of AP since they involve many parameters. <strong>Objectives of the study: </strong>The basic aim of the study is to analyze the </em><em>ranson score vs serum Procalcitonin for predicting the severity of acute pancreatitis in local population of Pakistan.</em> <strong><em>Materials and Methods</em></strong><em>: This cross-sectional study was carried out at </em><em>THQ Depalpur, Okara during 2018</em><em>. 50 consecutive patients meeting the inclusion and exclusion criteria were offered to enroll in the study after taking informed consent. The diagnosis of acute pancreatitis was based on acute upper abdominal pain associated with a serum amylase level greater than three times the normal value or an elevated serum lipase level and radiological evidence of acute pancreatitis.</em> <strong><em>Results: </em></strong><em>The data was collected from 50 patients of both genders. 20 were females and 30 males. The median patient age was 49 years. According to the Atlanta criteria, 56 patients were classified as mild AP and 44 as severe AP. There were no significant differences according to age (p= 0.24) and sex (p= 0.65). The causes of AP were biliary stone, idiopathic or miscellaneous; differences were not significant. Twenty patients died: sixteen of multiple organ failure and four of severe necrotizing pancreatitis; all twenty had severe AP. <strong>Conclusion: </strong>It is concluded that patients with acute pancreatitis, serum procalcitonin level at admission does not accurately predict the progression to severe acute pancreatitis.</em>
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Ekka, Nishith M. Paul, Gaurav Mishra, Vinod Kumar, Arun Kumar Tiwary, Tanushree Kar, and Ashutosh Tiwary. "Clinical pattern of acute pancreatitis in eastern India and comparison of Ranson, BISAP and APACHE II as a predictor of severity, local complications and mortality." International Surgery Journal 5, no. 11 (2018): 3707. http://dx.doi.org/10.18203/2349-2902.isj20184649.
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Background: Acute pancreatitis is the single most frequent gastrointestinal cause of hospital admissions. Scoring systems have been used since the 1970s for assessment of its severity. This study was aimed to assess the clinical pattern of acute pancreatitis and to compare various predicting systems like Ranson, BISAP and APACHE II in predicting severity, local complications and mortality in acute pancreatitis.Methods: In this prospective study, 91 consecutive cases of acute pancreatitis admitted, between April 2015 to March 2017, were studied. The diagnostic criteria include the presence of at least two of the three features; abdominal pain, serum amylase and lipase levels and findings on imaging studies. Patients were divided into two groups each, BISAP Ranson ≥3 and <3, APACHE II ≥8 and <8, and analyzed statistically.Results: Out of total of 91 patients, 81 were male and 14 were female with mean age was 36.14 years. Commonest aetiological factor was alcoholism in 57.89% followed by gallstones in 23.16%. Serum amylase was raised in 83.26% patients while 95.79% had raised serum lipase levels. 75.79% patients were of MAP while 24.21% patients were of MSAP and SAP. 7.37% patients developed local complications and mortality rate was 6.32%. All the scoring systems were found similar in predicting severity, local complication and mortality, had low sensitivity and high specificity (P value < 0.05).Conclusions: There is no ideal predicting system for acute pancreatitis. These scoring systems can be used to triage patients for better healthcare delivery.
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Chauhan, Rohit, Neeraj Saxena, Neeti Kapur, and Dinesh Kardam. "Comparison of modified Glasgow-Imrie, Ranson, and Apache II scoring systems in predicting the severity of acute pancreatitis." Polish Journal of Surgery 94, no. 4 (2022): 1–7. http://dx.doi.org/10.5604/01.3001.0015.8384.
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<b>Aim:</b> The course of acute pancreatitis is variable with patients at risk of poor outcomes. The purpose of this study was to compare Modified Glasgow-Imrie, Ranson, and APACHE II scoring systems in predicting the severity of acute pancreatitis. </br></br> <b> Material and Methods: </b> After a brief history, clinical examination and qualifying inclusion criteria, 70 patients (41 women, 29 men) diagnosed with acute pancreatitis were included in the study. The three scores were calculated for each patient and evaluated for their role in the assessment of specific outcomes. </br></br> <b>Results:</b> 34.3% patients were diagnosed with severe acute pancreatitis, while 65.7% patients had mild acute pancreatitis. A strong positive correlation was found between all the prognostic scores and the severity of disease. In the prediction of the severity of disease according to AUC, it was found that Glasgow-Imrie score had an AUC of 0.864 (0.756–0.973), followed very closely by APACHE II score with an AUC of 0.863 (0.758–0.968). APACHE II had the highest sensitivity (79.17%) in predicting severity while Glasgow-Imrie score was the most specific (97.83%) of all the scores. Patients with a Glasgow-Imrie score above the cut-off value of 3 had more complications and a longer hospital stay. </br></br> <b>Conclusion:</b> The Glasgow-Imrie score was comparable to APACHE II score and better than Ranson score statistically in predicting the severity of acute pancreatitis. Its administration in predicting the severity of acute pancreatitis is recommended.
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Chatzicostas, Constantinos, Maria Roussomoustakaki, Emmanouel Vardas, John Romanos, and Elias A. Kouroumalis. "Balthazar Computed Tomography Severity Index Is Superior to Ranson Criteria and APACHE II and III Scoring Systems in Predicting Acute Pancreatitis Outcome." Journal of Clinical Gastroenterology 36, no. 3 (2003): 253–60. http://dx.doi.org/10.1097/00004836-200303000-00013.
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Hussain, Tanveer, Muhammad Hanif, Ramlah Ghazanfor, Sarmad Arslan, Ibia Nawaz, and Muhammad Umar. "Acute Pancreatitis severity scoring index: Prospective study to identify determinants in Pakistan." Journal of Rawalpindi Medical College 24, no. 3 (2020): 264–69. http://dx.doi.org/10.37939/jrmc.v24i3.1412.
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Introduction: The purpose of the study was to compare different parameters used in Ranson’s Criteria, Bedside Index of Severity in Acute Pancreatitis (BISAP), Acute Physiology and Chronic Health Evaluation (APACHE-II), and modified computed tomography severity index (MCTSI) for predicting the severity of acute pancreatitis and formulate a new scoring system to assess the severity of acute pancreatitis based on their prognostic severity index in the local population.
 Materials and Methods: This prospective pilot study was conducted at Rawalpindi Medical University allied hospitals from August 2019 to December 2019. All patients with a diagnosis of acute pancreatitis were included in the study through non-probability convenient sampling. Different scoring parameters were entered into standardized proforma.
 Results: 100 patients were included in the pilot study with a mean age of 46.53 ± 15.324. Among 24 parameters from APACHE-II, Ranson’s, BISAP, and MCTSI, only 11 parameters, Pleural effusion (PE), Pancreatic necrosis (PN), LDH, serum Calcium (Sca++), Pulse, GCS, MCTS1, Base deficit, Po2, BUN-24, and BUN-48 were significantly related(at 10% level of significance) with the severity of acute pancreatitis. Similarly out of 24, 10 parameters AST, LDH, Sca++, Pulse, PE, PN, Base deficit, MCTS1, Po2, and BUN 48were significantly covered more than 50% of the area in AUC analysis. Our proposed criteria based on 9 parameters LDH, Sca++, Pulse, PE, PN, Base deficit, MCTS1, Po2, and BUN 48which were blowing by the two methods (ANOVA and ROC). The sensitivity and specificity were higher with our proposed criteria 93.1% and 60.6%respectively as compared to the Ranson’s, modified Ranson, BISAP, and APACHE-II criteria.
 Conclusion: The newly proposed criteria for the assessment of the severity of AP is superior as compared to old criteria.
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Aydoğdu Umaç, Gülbin, and Sarper Yilmaz. "Assessment of frontal QRS–T angle in distinguishing mild and severe acute pancreatitis in emergency department: A retrospective study." Medicine 103, no. 48 (2024): e40743. http://dx.doi.org/10.1097/md.0000000000040743.
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Acute pancreatitis (AP) is a disease that poses significant health risks with potential severe outcomes. Identifying markers for severity can aid in early intervention and improve prognoses. This study, conducted in the emergency department, investigates the QRS–T angle as a potential indicator of severity in patients with acute pancreatitis. This retrospective study included 367 patients diagnosed with AP, classified as either mild acute pancreatitis or severe acute pancreatitis based on Ranson criteria. The QRS–T angle was measured using standard 12-lead electrocardiogram, and the data were analyzed to compare the QRS–T angles between the mild acute pancreatitis and severe acute pancreatitis groups. This research adhered to the guidelines outlined in the Strengthening the Reporting of Observational Studies in Epidemiology statement. The study included 367 patients, 94% (n = 345) had mild pancreatitis while 6% (n = 22) had severe pancreatitis. Severe cases had a significantly higher median age (P < .001) and higher rates of hypertension and diabetes mellitus (P = .027, P = .011). Severe cases also had higher Ranson scores (3 [IQR 3–3.25] vs 1 [IQR 1–2], P < .001) and longer hospital stays (6 [IQR 2.75–11.5] days vs 3 [2–5] days, P = .029). Additionally, severe pancreatitis group showed higher QRS–T angle (P < .001), higher rates of abnormal QRS angles (31.8% vs 10.1%, P = .002), and QRS–T angles (31.8% vs 8.1%, P < .001). The QRS–T angle may serve as a valuable clinical tool for differentiating between mild and severe forms of acute pancreatitis. This could potentially help clinicians in stratifying patients according to their risk and tailoring their management accordingly.
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Harsoda, Rohan J., Sharma Vipin Jaishree, and Krishna Prasad G.V. "Evaluation of Different Scoring Systems in Predicting the Severity of Acute Pancreatitis." Journal of Evidence Based Medicine and Healthcare 7, no. 45 (2020): 2604–10. http://dx.doi.org/10.18410/jebmh/2020/537.
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BACKGROUND Accurate prediction of the severity of acute pancreatitis will help in identifying patients at increased risk for morbidity and mortality. We wanted to evaluate the different scoring systems in predicting the severity of acute pancreatitis. METHODS This cross-sectional study was undertaken in the Department of Surgery at a zonal hospital between April 2013 and December 2014. RESULTS 40 patients were selected and enrolled in the study as per the selection criteria. 20 (50 %) patients had fair outcome and 20 (50 %) had a poor outcome. Accuracy of different scoring systems in predicting patient outcome ranged from 45 % (48-hr APACHE II) to 62.5 % (Goris MOF at baseline and 48 hr). Baseline Goris MOF was 70 % sensitive and 55 % specific in prediction of poor outcome. It had an accuracy of 62.5 % in prediction of outcome. 48-hr Goris MOF was 80 % sensitive and 45 % specific in predicting the outcome. Baseline APACHE II scores were below the cut-off level in all the patients. 48-hr APACHE II scores were 5 % sensitive and 100% specific for prediction of outcome. Ranson score > 3 was 25 % sensitive and 90 % specific in the prediction of outcome. Balthazar score > 6 was 65 % sensitive and 55 % specific in prediction of outcome. Ranson score was found to have a limited sensitivity for different outcomes (ranging from 21.1 % to 50 %) but was found to have a high specificity (83.8 % to 90 %). CONCLUSIONS Goris scoring system (at 48 hrs) was found to be highly sensitive to different poor outcomes as well as duration of hospital stay. It also correlated with Balthazar scoring system, which was also highly sensitive to different poor outcomes studied. KEYWORDS Acute Pancreatitis, Prediction, Scoring System, APACHE II, Goris MOF, Ranson’s Score, Balthazar Score
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Subramani, Jayaprakash, Rajesh Prabhu, and Jagadeesapandian Palpandi. "Assessing the Severity of Acute Pancreatitis with CT Severity Index and Other Conventional Methods in a Tertiary Care Hospital in Tamil Nadu, India – A Comparative Cross-Sectional Study." Journal of Evidence Based Medicine and Healthcare 8, no. 41 (2021): 3541–46. http://dx.doi.org/10.18410/jebmh/2021/642.
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BACKGROUND Acute pancreatitis is not uncommon in surgical practice with variable clinical presentation. Because of its potential notable catastrophic complications, it is mandatory to assess the severity at the earliest. In recent times, the decision making in the management is quite difficult due to its complications and outcome. So, an objective assessment of severity based on clinical and laboratory scoring verses computed tomography (CT) severity is still debate, hence the need for study. The purpose of this study was to compare the efficiency of CT severity index verses APACHE II and Ranson criteria in predicting the severity of acute pancreatitis. METHODS A total number of 36 consecutive cases of acute pancreatitis who were admitted between January 2013 and December 2014 in Apollo Specialty Hospitals – Madurai were included in the study. Written informed consent was obtained from all study participants. RESULTS In our study, out of 36 patients, 30 (83.33 %) were males and 6 (16.66 %) were females. The sex distribution shows a clear male predominance. Most of the patients in the present study belonged to the middle age group. Alcohol was the most common cause accounting for 41.7 % of the cases followed by the billiary pathology. CT severity index was the superior tool for prediction of the prognosis and early complications. CONCLUSIONS When using contrast enhanced computed tomography, it was found that there was a significant correlation between the development of organ failure and severity of pancreatitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Ranson and acute physiology and chronic health evaluation – II (APACHE II) at 48 hours of admission with acute pancreatitis does not correlate in determining the severity of acute pancreatitis. KEYWORDS Acute Pancreatitis, Severity Markers, CT Severity Index
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Hammond, Drayton A., and Laura Finlay. "Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis With Insulin, Heparin, and Gemfibrozil: A Case Series." Hospital Pharmacy 52, no. 10 (2017): 675–78. http://dx.doi.org/10.1177/0018578717725168.
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Hypertriglyceridemia is the third most common worldwide cause of acute pancreatitis. Resolving the underlying etiology is imperative for optimal management. This is especially true with regard to hypertriglyceridemia, as this etiology may cause more severe acute pancreatitis and worse symptoms than other causes of the disease. Many pharmacological treatment options for hypertriglyceridemia-induced acute pancreatitis (HTGP) have been proposed; however, the safety and efficacy for specific treatment regimens remain nebulous. At our institution, 6 patients, whose average Ranson criteria score were 5 and presenting triglyceride concentrations were 3501 mg/dL, were managed with a continuous infusion of insulin, subcutaneous heparin, and oral gemfibrozil for HTGP. Maximum insulin infusion rates ranged from 0.8 to 20.9 U/h. Half of the patients received nongemfibrozil cholesterol medication. Five patients experienced a resolution of HTGP (median day 3). The only adverse drug event was hypoglycemia in a single patient. Combination therapy with heparin, insulin, and gemfibrozil is safe and efficacious in quickly lowering serum triglyceride concentrations in HTGP. This combination warrants further study.
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JAIN, Deepak, Gourab BHADURI, and Promil JAIN. "DIFFERENT SCORING SYSTEMS IN ACUTE ALCOHOLIC PANCREATITIS: WHICH ONE TO FOLLOW? AN ONGOING DILEMA." Arquivos de Gastroenterologia 56, no. 3 (2019): 280–85. http://dx.doi.org/10.1590/s0004-2803.201900000-53.
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ABSTRACT BACKGROUND: Acute pancreatitis is a common disorder in medical practice. In recent times, management has changed drastically with majority of decisions like intravenous antibiotics, negative suction with Ryle’s tube and surgical interventions like necrosectomy etc based on severity of the disease. There are different scores in use to assess severity of disease but the relative efficacy has remained a debatable subject. OBJECTIVE: The present study was thus done to investigate the predictive accuracy of different scoring systems in acute pancreatitis. METHODS: Fifty patients of acute pancreatitis admitted in medicine ward of Pt. B.D. Sharma PGIMS, Rohtak, India, were taken for study after fulfilling eligibility criteria. These patients were investigated at admission and followed up prospectively. The severity of pancreatitis was classified for each of these patients as per Revised Atlanta System of Classification. Commonly used scoring systems pertaining to acute pancreatitis, viz, BISAP, Ranson, APACHE II and modified computed tomography severity index (CTSI) were calculated. Subsequently these scores were then correlated with severity, presence of organ failure, occurrence of local complications and final outcome of the patients. RESULTS: Out of 50 patients, etiology was chronic alcohol intake in all but one with idiopathic pancreatitis. The mean age of the study population was 42.06±13.27 years. 32% of these patients had pancreatic necrosis, 40% had peripancreatic collections. 56% of them had mild acute pancreatitis, 24% had moderately severe acute pancreatitis, while 20% had severe acute pancreatitis. APACHE II had the highest accuracy in predicting severity, organ failure and fatal outcomes. As far as these parameters were concerned, the negative predictive values of BISAP score were also considerable. Modified CTSI score was accurate in predicting local complications but had limited accuracy in other predictions. CONCLUSION: APACHE II emerged as most reliable scoring system followed by BISAP and Ranson in management of the patients with acute pancreatitis. But in constraints of time and resources, even BISAP score with its significant negative predictive values served as a valuable tool for assessing and managing these patients.
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Khan, Mahlail Hasan, Uzma Javed Gul, Khurrum Sarfaraz Bajwa, Tariq Kamal, Sajid Ameer Fahim, and Uroosa Din Muhammad. "Red Cell Distribution Width with Platelet Count Ratio as a Marker of Severity in Acute Biliary Pancreatitis." Pakistan Armed Forces Medical Journal 75, no. 2 (2025): 254–57. https://doi.org/10.51253/pafmj.v75i2.9145.
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Objective: To evaluate and compare red cell distribution width-to-platelet count ratio (RPR) as marker of severity among patients managed for mild and severe acute biliary pancreatitis. Study Design: Cross-sectional study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Apr 2021 to Mar 2022. Methodology: Patients were diagnosed with mild or severe acute pancreatitis by using the modified Atlanta criteria: (1) Epigastric pain (2) Increased serum lipase levels, and (3) CT imaging findings indicative of acute pancreatitis. Patients with comorbidities including ischemic heart disease, cerebrovascular accidents, or pregnant females were excluded. The clinical severity of illness was assessed by Ranson and Glasgow scores at the time of admission and at 48 hours. Red cell distribution width-to-platelet count ratio (RPR) values were also assessed at the time of admission. Patient mortality was assessed at 7 days post admission and at 30 days after discharge. Results: Out of a total of 45 patients, mean age was estimated at 47.6±12.0 years while 20(44%) cases fulfilled the criteria of severe acute pancreatitis. Mean RPR values were significantly increased among patients with severe clinical illness (p<0.001) and among non-surviving cases (p=0.014). Nine (20%) patients died during the 30-day follow-up. Conclusion: Red cell distribution width-to-platelet count ratio is a substantially efficient parameter in the early diagnosis of severe acute pancreatitis.
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Imrie, Clement W. "Prognostic Indicators in Acute Pancreatitis." Canadian Journal of Gastroenterology 17, no. 5 (2003): 325–28. http://dx.doi.org/10.1155/2003/250815.
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Several approaches have been used in an attempt to predict the severity and prognosis of attacks of acute pancreatitis. The Ranson and Glasgow criteria include a variety of simple laboratory parameters that are measured on admission and again within 48 h. They are the most widely used indices in clinical practice. The Acute Physiological and Chronic Health Evaluation II system is more complicated, but can be applied to a wide variety of conditions, especially in intensive care settings. The usefulness of this system depends on the threshold score for defining severe pancreatitis; a score of eight appears to be the most appropriate. The finding of nonperfused areas in the pancreas at contrast-enhanced computed tomography is indicative of pancreatic necrosis and portends an unfavourable prognosis. Other clinical and laboratory indices have been proposed, but the most important predictive factor of early mortality seems to be the presence and persistance of a Marshall organ failure score of two or more. This is especially true if organ dysfunction persists beyond 36 h. Radiological findings do not always correlate well with the presence of organ dysfunction, and more investigations are required.
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Amália Cinthia Meneses do Rêgo and Irami Araújo-Filho. "Decision-making in severe acute pancreatitis: The role of artificial intelligence and severity scales." World Journal of Advanced Research and Reviews 23, no. 1 (2024): 2899–908. http://dx.doi.org/10.30574/wjarr.2024.23.1.2255.
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Severe acute pancreatitis (SAP) presents a complex clinical scenario that demands prompt and accurate decision-making regarding the appropriate course of treatment. The management of SAP involves a delicate balance between surgical intervention and conservative therapy, aiming to optimize patient outcomes while minimizing morbidity and mortality. Traditional methods of assessing disease severity, such as the Balthazar scale, Ranson criteria, Glasgow-Imrie score, and APACHE II score, provide valuable clinical insight but may lack the precision necessary for individualized patient care. In recent years, integrating artificial intelligence (AI) technologies into healthcare has shown promise in augmenting clinical decision-making processes. By leveraging machine learning algorithms and predictive analytics, AI has the potential to enhance the accuracy and efficiency of severity assessment in SAP. This article explores the role of AI in conjunction with existing severity scales in aiding surgeons' decision-making regarding the timing and modality of intervention in patients with SAP. Through a comprehensive review of current literature and case studies, we will examine the advantages and limitations of AI-based approaches and propose strategies for integrating these technologies into clinical practice. By harnessing the power of AI, surgeons can potentially optimize patient outcomes, improve resource utilization, and reduce the burden of SAP on healthcare systems worldwide.
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Araujo-Filho, Irami, and Amália Cinthia Menseses Rêgo. "Decision-Making in Severe Acute Pancreatitis: The role of Artificial Intelligence and Severity Scales." JOURNAL OF SURGICAL AND CLINICAL RESEARCH 15, no. 2 (2024): 173–86. https://doi.org/10.21680/2179-7889.2024v15n2id36173.
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Severe acute pancreatitis (SAP) presents a complex clinical scenario that demands prompt and accurate decision-making regarding the appropriate course of treatment. The management of SAP involves a delicate balance between surgical intervention and conservative therapy, aiming to optimize patient outcomes while minimizing morbidity and mortality. Traditional methods of assessing disease severity, such as the Balthazar scale, Ranson criteria, Glasgow-Imrie score, and APACHE II score, provide valuable clinical insight but may lack the precision necessary for individualized patient care. In recent years, integrating artificial intelligence (AI) technologies into healthcare has shown promise in augmenting clinical decision-making processes. By leveraging machine learning algorithms and predictive analytics, AI has the potential to enhance the accuracy and efficiency of severity assessment in SAP. This article explores the role of AI in conjunction with existing severity scales in aiding surgeons' decision-making regarding the timing and modality of intervention in patients with SAP. Through a comprehensive review of current literature and case studies, we will examine the advantages and limitations of AI-based approaches and propose strategies for integrating these technologies into clinical practice. By harnessing the power of AI, surgeons can potentially optimize patient outcomes, improve resource utilization, and reduce the burden of SAP on healthcare systems worldwide.
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Amália, Cinthia Meneses do Rêgo, and Araújo-Filho Irami. "Decision-making in severe acute pancreatitis: The role of artificial intelligence and severity scales." World Journal of Advanced Research and Reviews 23, no. 1 (2024): 2899–908. https://doi.org/10.5281/zenodo.14830484.
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Severe acute pancreatitis (SAP) presents a complex clinical scenario that demands prompt and accurate decision-making regarding the appropriate course of treatment. The management of SAP involves a delicate balance between surgical intervention and conservative therapy, aiming to optimize patient outcomes while minimizing morbidity and mortality. Traditional methods of assessing disease severity, such as the Balthazar scale, Ranson criteria, Glasgow-Imrie score, and APACHE II score, provide valuable clinical insight but may lack the precision necessary for individualized patient care. In recent years, integrating artificial intelligence (AI) technologies into healthcare has shown promise in augmenting clinical decision-making processes. By leveraging machine learning algorithms and predictive analytics, AI has the potential to enhance the accuracy and efficiency of severity assessment in SAP. This article explores the role of AI in conjunction with existing severity scales in aiding surgeons' decision-making regarding the timing and modality of intervention in patients with SAP. Through a comprehensive review of current literature and case studies, we will examine the advantages and limitations of AI-based approaches and propose strategies for integrating these technologies into clinical practice. By harnessing the power of AI, surgeons can potentially optimize patient outcomes, improve resource utilization, and reduce the burden of SAP on healthcare systems worldwide.
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Ucdal, Mete, Amir Bakhshandehpour, Muhammed Bahaddin Durak, Yasemin Balaban, Murat Kekilli, and Cem Simsek. "Evaluating the Role of Artificial Intelligence in Making Clinical Decisions for Treating Acute Pancreatitis." Journal of Clinical Medicine 14, no. 12 (2025): 4347. https://doi.org/10.3390/jcm14124347.
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Background/Objectives: Acute pancreatitis (AP) is an illness that requires prompt diagnosis and treatment since it has the potential to become life-threatening. The American College of Gastroenterology 2024 (ACG24) guidelines offer a framework for diagnosis, severity, and treatment criteria. To assess Google Gemini application of ACG24 guidelines to Medical Information Mart for Intensive Care-III AP cases for risk, nutrition, and complication management. Methods: This observational cross-sectional study was based on 512 patients with AP who were treated in the Medical Information Mart for Intensive Care-III database from 2001 to 2012. The study compared the efficiency of Gemini in relation to the ACG24 guidelines in the three main areas of risk stratification, enteral nutrition timing, and necrotizing pancreatitis management. Enteral nutrition, according to the ACG24 guidelines, should be started within 48 h for patients who are capable, and antibiotics should only be used for confirmed infected necrosis. Results: The study included 512 patients who were divided into two groups: 213 patients with mild pancreatitis (41.6%) and 299 patients with severe pancreatitis (58.4%). The model achieved 85% accuracy for mild cases and 82% accuracy for severe cases of pancreatitis. The Acute Physiology and Chronic Health Evaluation II and Ranson scores matched the predictions of Gemini for both mild cases (p = 0.28 and p = 0.33, respectively) and severe cases (p = 0.31 and p = 0.27, respectively). The recommendations for early enteral nutrition and delayed feeding in mild cases were correct for 78% of patients, but the system suggested oral intake prematurely in 8% of severe cases. The antibiotic guideline compliance reached 82% among 156 patients with necrotizing pancreatitis, and the procedure for draining infected necrosis was correct 85% of the time. Conclusions: The Gemini model achieved 78–85% accuracy in determining pancreatitis severity and adherence to treatment guidelines but showed lower accuracy in nutrition timing compared to other parameters. Core Tip: This study evaluated the Google Gemini model in applying the American College of Gastroenterology 2024 guidelines for acute pancreatitis across 512 Medical Information Mart for Intensive Care-III cases. Results demonstrated 85% accuracy in severity classification, precise prediction of Acute Physiology and Chronic Health Evaluation II and Ranson scores, and 78–85% compliance with nutritional and necrotizing pancreatitis management guidelines. These findings suggest that artificial intelligence-based clinical decision support systems can provide rapid, consistent, and guideline-concordant recommendations, which are particularly valuable in settings with limited specialist expertise.
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Milnerowicz, Halina, Radosław Bukowski, Monika Jabłonowska, Milena Ściskalska, and Stanisław Milnerowicz. "The Antioxidant Profiles, Lysosomal and Membrane Enzymes Activity in Patients with Acute Pancreatitis." Mediators of Inflammation 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/376518.
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Oxidative stress and inflammatory mediators, such as IL-6, play an important role in the pathophysiology of acute pancreatitis. The study was aimed to assess the degree of the pro/antioxidative imbalance and estimate which antioxidant plays a role in the maintenance of pro/antioxidative balance during acute pancreatitis. The study was investigated in the blood of 32 patients with acute pancreatitis and 37 healthy subjects. IL-6 concentration as early marker of inflammation was determinated. The intensity of oxidative stress was assessed by TBARS concentration. To investigate antioxidative status, the GPx and Cu/Zn SOD activities and the levels of GSH, MT, SH groups, and TRAP were measured. The concentrations of Cu and Zn as ions participating in the maintenance of antioxidant enzymes stability and playing a role in the course of disease were determinated. The activities of GGT, AAP, NAG, andβ-GD as markers of tissue damage were also measured. An increase in IL-6 concentration, which correlated with Ranson criteria, and an increase in GPx activity, levels of MT, TBARS, or GGT, and NAG activities in patients group compared to healthy subjects were demonstrated. A decrease in GSH level in patients group compared to control group was noted. The studies suggest that GPx/GSH and MT play the role of the first line of defence against oxidative stress and pro/antioxidant imbalance in the course of acute pancreatitis.
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Lankisch, Paul Georg, Christine Assmus, Dirk Lehnick, Patrick Maisonneuve, and Albert B. Lowenfels. "Acute pancreatitis: Does gender matter?" Digestive diseases and sciences 46, no. 11 (2001): 2470, 2474. https://doi.org/10.5281/zenodo.4555215.
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In a number of gastrointestinal and nongastrointestinal diseases, gender has been proven to be an independent risk factor for severity. To determine whether this holds true for severity in acute pancreatitis is the aim of our study. This paper derives from a prospective study on the epidemiology of acute pancreatitis, which included 274 patients (172 male and 102 female) with a first attack of the disease. Severity parameters were: Atlanta criteria (arterial Po2 textless or = 60 mm Hg, and serum creatinine on admission textgreater2 mg/dl after rehydration); Ranson`s and Imrie`s prognostic factors; APACHE II score; Balthazar-scored contrast-enhanced computed tomography (CT) results obtained within 72 hr of admission; days spent in the intensive care unit and total hospital stay; the necessity for artificial ventilation, dialysis, or surgery; and mortality. As already known, there is a significant association between gender and etiology of pancreatitis in general. Not surprisingly, the men in our study had alcohol-induced acute pancreatitis more frequently than women, whereas biliary pancreatitis predominated among the women. As for severity, there was no significant association between gender and any of the severity parameters with a few minor exceptions: longer hospital stays, higher Imrie scores and more pseudocysts for women, and more necroses in women with idiopathic pancreatitis. Thus, gender is no independent risk factor for the severity and outcome of acute pancreatitis.
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Valeev, A. A. "Assessment of the severity of acute destructive pancreatitis for proper treatment selection." Kazan medical journal 94, no. 5 (2013): 633–36. http://dx.doi.org/10.17816/kmj1906.
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The review covers the most common integrated scales used for the assessment of severity of acute destructive pancreatitis. The use of those scales in the surgical in-patient department is discussed. Different views of Russian and foreign pancreatologists on the use of integrated scales to predict the disease outcome according to various criteria (clinical, laboratory, and special examination methods) are presented. Because of the acute pancreatitis morphological forms variety at admission for urgent surgery, there is a need for a comprehensive assessment of the disease severity in such patients. First stage of assessment is based on clinical data obtained at admission; correlation with systemic organ failure is also taken into account. This approach helps to distinguish mild, moderate and severe clinical course of disease. The use of multiple integral scales used for clinical assessment, with the number of possible options exceeding 20, is widely applied when the patient is admitted. The surgeon’s selection of a scale for assessment of the disease severity depends on the available equipment and the time for evaluation. Currently, the multi-parameter prognostic scales Ranson (1972), APACHE II (Acute Physiology And Chronic Health Evaluation, 1990), Glasgow-Imrie (1984), SAPS (Simplified acute physiology score, 1984), MODS (Multiple Organ Dysfunction Score, 1995), SOFA (Sepsis-related Organ Failure. 1996) are considered to be most objective. The use of these scales allows improving the prediction of outcome and necrotic complications by several times.
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Mikhailov, A. Yu, E. V. Khalimov, and V. V. Remnyakov. "Application of autoplasma enriched with thrombocytes in the comprehensive treatment of acute pancreatitis." Grekov's Bulletin of Surgery 183, no. 4 (2024): 21–27. http://dx.doi.org/10.24884/0042-4625-2024-183-4-21-27.
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The OBJECTIVE was to assess the proposed treatment method for patients with acute pancreatitis in the 1 A phase of the disease’s development.METHODS AND MATERIALS. The data from the treatment of patients in the surgical departments of the City Clinical Hospital ¹ 6 in Izhevsk (Clinic of the Department of General Surgery, Izhevsk State Medical Academy) were ana lyzed. Two groups of patients with acute pancreatitis in the 1A phase of the disease development were formed. In the observation group, in addition to the basic treatment, autoplasmic thrombocyte concentrate was administered into the round ligament of the liver. The dynamics of the process and treatment outcomes were assessed based on the criteria scale of primary express assessment of acute pancreatitis severity by the St. Petersburg Research Institute named after I. I. Dzhanelidze (2006), leukocyte index of intoxication by V. K. Ostrovsky (2018), and the J. Ranson scale (1974).RESULTS. The use of autoplasmic thrombocyte concentrate in the observation group allows reducing the number of minimally invasive interventions to 17.7 %, or by 42.1 %, and the number of laparotomies to 5, or by 54.5 %, compared to the comparison group, avoiding fatal outcomes.CONCLUSION. The use of autoplasmic thrombocyte concentrate in the comprehensive treatment of patients with acute pancreatitis in the 1 A phase of development and its targeted delivery through the round ligament of the liver allows preventing lethality, reducing the number of complications of acute pancreatitis requiring surgical intervention.
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Ratiu, Iulia, Renata Bende, Camelia Nica, et al. "Prediction Models of Severity in Acute Biliary Pancreatitis." Diagnostics 15, no. 2 (2025): 126. https://doi.org/10.3390/diagnostics15020126.
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Background: Acute pancreatitis is a common condition with a variable prognosis. While the overall mortality rate of acute pancreatitis is relatively low, ranging between 3 and 5% in most cases, severe forms can result in significantly higher morbidity and mortality. Therefore, early risk assessment is crucial for optimizing management and treatment. The aim of the present study wasto compare simple prognostic markers and identify the best predictors of severity in patients with acute pancreatitis. Material and Methods: A retrospective analysis was carried outon 108 patients admitted in our center during one year with acute biliary pancreatitis. Acute pancreatitis severity was stratified based on the revised Atlanta criteria. Results: 108 subjects (mean age of 60.1 ± 18.6, 65.7% females) diagnosed with acute biliary pancreatitis were included. Based on the Atlanta criteria, 59.3% (64/108) of the subjects were classified as having mild acute biliary pancreatitis, 35.2% (38/108) as having a moderate–severe pancreatitis, and 5.5% (6/108) were classified as having severe acute pancreatitis. In univariate analysis, the following parameterswere associatedwith at least a moderate–severe form of acute pancreatitis: Balthazar score, fasting blood glucose (mg/dL), modified CTSI score, CRP values at 48 h, BISAP score at admission, CTSI score, Ranson score, duration of hospitalization (days), and the presence of leukocytosis (×1000/µL) (all p < 0.05).BISAP score at admission (AUC-0.91), CRP levels at 48 h (AUC-0.92), mCTSI (AUC-0.94), and CTSI score (AUC-0.93) had the highest area under the curve (AUC) for predicting the severity of acute pancreatitis. In multivariate analysis, the model including the following independent parameters was predictive for the severity of acute pancreatitis: CTSI score (p < 0.0001), BISAP score (p = 0.0082), and CRP levels at 48 h (p = 0.0091), respectively. The model showed a slightly higher AUC compared to the independent predictors (AUC-0.96). Conclusions: The use of a multiparametric prediction model can increase the accuracy of predicting severity in patients with acute biliary pancreatitis.
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Leghari, Muhammad Ajmal, Waseem Ahmed Khan, Imran Ashraf, Abdul Hameed, Ahmad Tariq, and Muhammad Bilal Sikandar Nagra. "Outcome Analysis of APACHE-II Scoring System in Predicting 30 Days Mortality in Acute Pancreatitis in Tertiary Care Hospital." Pakistan Armed Forces Medical Journal 75, no. 1 (2025): 133–37. https://doi.org/10.51253/pafmj.v75i1.11619.
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Objective: To evaluate outcome analysis of Apache-II scoring system in predicting 30 days mortality in acute pancreatitis in tertiary care hospital. Study Design: Prospective longitudinal study. Place and Duration of Study: Combined Military Hospital Rawalpindi, Pakistan from August 2023 and December 2023. Methodology: One hundred patients with acute pancreatitis were examined retrospectively. Individuals who met the Ranson criteria or were hospitalized for>2 months were chosen. Mortality, organ failure, and pancreatic necrosis were the primary outcome measures. On the other hand, the occurrence of organ failure was analyzed with a score of Apache II at admission to the hospital. Results: The 48-hour score was significantly correlated with organ failure (p=0.001), pancreatic necrosis (p<0.01), and mortality (p<0.01). In contrast, organ failure was the only factor with which the score at admission had a significant relationship (p=.007). A fatal outcome had a considerable connection (p=.03) with declining scores over 48 hours. The overall score of Apache II was substantially higher in non-survivors (p<.001) and was highly correlated with organ failure (p<.001) and pancreatic necrosis (p=.001). In contrast to 74% based on the admission score, 92% of patients had their outcomes correctly predicted by the 48-hour and combined scores. Conclusion: The 48-hour score has a better prognostic value than the admission score in predicting which individuals with severe acute pancreatitis will have a poor prognosis. A declining APACHE II score 48 hours after admission identifies individuals who are at risk for negative results.
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Gezer, Naciye S., Göksel Bengi, Agah Baran, et al. "Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis." Revista da Associação Médica Brasileira 66, no. 6 (2020): 762–70. http://dx.doi.org/10.1590/1806-9282.66.6.762.
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SUMMARY Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis BACKGROUND/AIMS To compare radiological scoring systems, clinical scores, serum C-reactive protein (CRP) levels and the neutrophil-lymphocyte ratio (NLR) for predicting the severity and mortality of acute pancreatitis (AP). MATERIALS AND METHODS Demographic, clinical, and radiographic data from 80 patients with AP were retrospectively evaluated. The harmless acute pancreatitis score (HAPS), systemic inflammatory response syndrome (SIRS), bedside index for severity in acute pancreatitis (BISAP), Ranson score, Balthazar score, modified computed tomography severity index (CTSI), extrapancreatic inflammation on computed tomography (EPIC) score and renal rim grade were recorded. The prognostic performance of radiological and clinical scoring systems, NLR at admission, and serum CRP levels at 48 hours were compared for severity and mortality according to the revised Atlanta Criteria. The data were evaluated by calculating the receiver operator characteristic (ROC) curves and area under the ROC (AUROC). RESULTS Out of 80 patients, 19 (23.8%) had severe AP, and 9 (11.3%) died. The AUROC for the BISAP score was 0.836 (95%CI: 0.735-0.937), with the highest value for severity. With a cut-off of BISAP ≥2, sensitivity and specificity were 68.4% and 78.7%, respectively. The AUROC for NLR was 0.915 (95%CI: 0.790-1), with the highest value for mortality. With a cut-off of NLR >11.91, sensitivity and specificity were 76.5% and 94.1%, respectively. Of all the radiological scoring systems, the EPIC score had the highest AUROC, i.e., 0.773 (95%CI: 0.645-0.900) for severity and 0.851 (95%CI: 0.718-0.983) for mortality, with a cut-off value ≥6. CONCLUSION The BISAP score and NLR might be preferred as early determinants of severity and mortality in AP. The EPIC score might be suggested from the current radiological scoring systems.
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T., Kemparaj, Narasimhamurthy K. N., and Archit Muralidhar. "Total serum calcium and corrected calcium as a predictor of severity in acute pancreatitis." International Surgery Journal 5, no. 11 (2018): 3558. http://dx.doi.org/10.18203/2349-2902.isj20184622.
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Background: Acute pancreatitis is an acute inflammatory process of the pancreas. The Ranson and the modified Glasgow scores require 48 hours of data collection to asses’ severity. Hypocalcaemia is one of the components of Ranson's scoring system done to assess the severity of pancreatitis. Albumin-corrected calcium (ACC) has also been associated with severity, but no study has evaluated it as a prognostic severity factor within the first 24 h of the patient’s hospital admission. This study tries to evaluate total calcium and albumin corrected calcium as prognostic severity markers in acute pancreatitis within first 24 hour of admission.Methods: This prospective study was conducted in Bowring and Lady Curzon hospital, a tertiary care centre from June 2016 to May 2018. Inclusion criteria included all patients above 18 years of age, who presented within 72 hours of onset of epigastric pain. The clinical and demographic data with respect to gender, age, previous history of pancreatitis, total calcium taken 24 h after admission. In order to evaluate total calcium and albumin corrected calcium as prognostic factors of severity, the lowest total calcium values were collected within the first 24 h of hospital admission. These values were then corrected according to the serum albumin level.Results: A total of ninety-four patients were included in the study. There was no significant difference in the age of patients in each severity grade (p value: 0.242). No difference was observed in gender distribution of three groups. (P >0.05). As compared to total calcium, mean values of albumin corrected calcium were 8.03, 7.18 and 6.28 for mild, moderate and severe acute pancreatitis respectively, which were also significant at 0.05.Conclusions: Total calcium and albumin-corrected calcium obtained within the first 24 hours of hospital admission are useful predictors of severity in acute pancreatitis.
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Koziel, Dorota, Stanislaw Gluszek, Jaroslaw Matykiewicz, Piotr Lewitowicz, and Zuzanna Drozdzak. "Comparative Analysis of Selected Scales to Assess Prognosis in Acute Pancreatitis." Canadian Journal of Gastroenterology and Hepatology 29, no. 6 (2015): 299–303. http://dx.doi.org/10.1155/2015/392643.
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OBJECTIVE: To evaluate the utility of selected scales to prognosticate the severity and risk for death among patients with acute pancreatitis (AP) according to the revised Atlanta classification published in 2012.METHODS: Prospective data regarding patients hospitalized due to AP were analyzed. The final analysis included a total of 1014 patients. The bedside index for severity in acute pancreatitis (BISAP), Panc 3 scores and Ranson scales were calculated using data from the first 24 h of admission.RESULTS: Mild AP was diagnosed in 822 (81.1%) cases, moderate in 122 (12%) and severe in 70 (6.9%); 38 (3.7%) patients died. The main causes of AP were cholelithiasis (34%) and alcohol abuse (26.7%). Recurrence of AP was observed in 244 (24.1%) patients. In prognosticating the severity of AP, the most useful scale proved to be the Acute Physiology and Chronic Health Evaluation (APACHE) II (area under the curve [AUC] 0.724 [95% CI 0.655 to 0.793]), followed by BISAP (AUC 0.693 [95% CI 0.622 to 0.763]). In prognosticating a moderate versus mild course of AP, the CT severity index proved to be the most decisive (AUC 0.819 [95% CI 0.767 to 0.871]). Regarding prognosis for death, APACHE II had the highest predictive value (AUC 0.726 [95% CI 0.621 to 0.83]); however, a similar sensitivity was observed using the BISAP scale (AUC 0.707 [95% CI 0.618 to 0.797]).CONCLUSIONS: Scoring systems used in prognosticating the course of the disease vary with regard to sensitivity and specificity. The CT severity index scoring system showed the highest precision in prognosticating moderately severe AP (as per the revised Atlanta criteria, 2012); however, in prognosticating a severe course of disease and mortality, APACHE II proved to have the greatest predictive value.
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Popuri, Madan, and VPL Chandrakumar Sistla. "Intra-abdominal Pressure as a Prognostic Factor in Severe Acute Pancreatitis." Perspectives in Medical Research 10, no. 1 (2022): 99–102. http://dx.doi.org/10.47799/pimr.1001.19.
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Abstract Objective:To assess the prognostic value of Intra-abdominal Pressure in severe acute pancreatitis, compare it to APACHE II, to determine when to intervene based on intra abdominal pressure. Materials and Methods:We studied the role of intra-abdominal pressure measurement as a prognostic index and its applicability to determine the timing of intervention in cases of severe acute pancreatitis as a prospective cohort study from 2010- 2012, at Kamineni Hospital, L.B Nagar, Hyderabad. All patients who were admitted with severe acute pancreatitis and consented to take part in the study were enrolled. All patients were evaluated clinically, radiologically, biochemically and by the prognostic indices – APACHE II, Ranson criteria and intra-abdominal pressure measurement. A total of 55 patients were enrolled in this study. Intra-abdominal pressure was measured by intravesical technique using a Foley catheter.Intra-abdominal pressure was measured every 12 hours. Within 24 hours of admission, APACHE II score was obtained. Multivariate analysis was utilised for statistics. Results:Males comprised 73% of study population. Mean age was 41.23± 13.74 years (17- 83 years). Ten patients (18.81%) died. Among the non-survivors, the intra-abdominal pressure (20.1± 3.1073 Vs 8.97± 4.39) and the APACHE II (17.5 ±4.09 Vs3.93 ±4.345),were significantly greater, P value <0.0001. The AUC for intra-abdominal pressureat 24 hours and at 72 hours was >0.7, which is highly significant. The sensitivity for intra-abdominal pressure(>13 mm Hg) at 72 hours as a marker for mortality was 100%. Conclusion:The Intra-abdominal pressure monitoring is rapid, reproducible, inexpensive and minimally invasive, and can be used as a marker of the severity and prognosis of severe acute pancreatitis. Intra-abdominal pressure could potentially be used to guide the timing of intervention. Compared to APACHE II, which is inclusive of multiple parameters, intra-abdominal pressure can serve the same purpose as a single prognostic index. Further, we recommend a large, multicentric studies to conclusively establish the predictive power of intra-abdominal pressure in acute pancreatitis and whether interventions known to reduce intra-abdominal pressure, can alter the ultimate outcome.
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Han, Fei, Xiao-lei Shi, Jia-jia Pan, et al. "Elevated serum HbA1c level, rather than previous history of diabetes, predicts the disease severity and clinical outcomes of acute pancreatitis." BMJ Open Diabetes Research & Care 11, no. 1 (2023): e003070. http://dx.doi.org/10.1136/bmjdrc-2022-003070.
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IntroductionThe aim of our study is to explore the value of serum glycosylated hemoglobin A1c (HbA1c) in disease severity and clinical outcomes of acute pancreatitis (AP).Research design and MethodsPatients with AP were included from January 2013 to December 2020, retrospectively, dividing into normal serum HbA1c level (N-HbA1c) group and high serum HbA1c level (H-HbA1c) group according to the criteria HbA1c <6.5%. We compared patient characteristics, biochemical parameters, disease severity, and clinical outcomes of patients with AP in two groups. Besides, we evaluated the efficacy of serum HbA1c to predict organ failure (OF) in AP patients by receiver operating curve (ROC).ResultsWe included 441 patients with AP, including 247 patients in N-HbA1c group and 194 patients in H-HbA1c group. Serum HbA1c level was positively correlated with Atlanta classification, systemic inflammatory response syndrome, local complication, and OF (all p<0.05). Ranson, BISAP (bedside index of severity in acute pancreatitis), and CT severity index scores in patients with H-HbA1c were markedly higher than those in patients with N-HbA1c (all p<0.01). ROC showed that the best critical point for predicting the development of OF in AP with serum HbA1c is 7.05% (area under the ROC curve=0.79). Logistic regression analysis showed H-HbA1c was the independent risk factor for the development of OF in AP. Interestingly, in patients with presence history of diabetes and HbA1c <6.5%, the severity of AP was significantly lower than that in H-HbA1c group. Besides, there was no significant difference between with and without history of diabetes in N-HbA1c group.ConclusionsGenerally known, diabetes is closely related to the development of AP, and strict control of blood glucose can improve the related complications. Thus, the level of glycemic control before the onset of AP (HbA1c as an indicator) is the key to poor prognosis of AP, rather than basic history of diabetes. Elevated serum HbA1c level can become the potential indicator for predicting the disease severity of AP.
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G, Hemanth, and Srinivas L. "Role of C-Reactive Protein in Predicting the Severity of Acute Pancreatitis." International Journal of Toxicological and Pharmacological Research 13, no. 6 (2023): 236–41. https://doi.org/10.5281/zenodo.11180321.
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<strong>Background:</strong> Intense abdominal pain is commonly caused by acute pancreatitis. The effectiveness of diagnostic markers such as pancreatic enzymes (such as amylase and lipase) in predicting outcomes has been disappointing. However, assessing C-reactive protein (CRP) offers a cost-effective and efficient alternative. In this study, we have investigated whether an early assessment of CRP levels can serve as a reliable predictor of morbidity and mortality in cases of acute pancreatitis. <strong>Methods:</strong> The patients were selected based on the inclusion and exclusion criteria and the demographic profile of the cases was recorded based on a pre-structured proforma. A detailed clinical examination was carried out on the patients and findings were noted. Serum C-reactive protein (CRP) levels were measured serially at 24 hrs, 48 hrs, and 72 hours following admission. At the 72-hour mark, computed tomography (CT) scans were conducted using oral and intravenous contrast agents to determine the CT severity index, including Balthazar’s and Ranson’s scores, as well as assess the CT grade and necrosis grade. <strong>Results:</strong> The comparison of CRP versus necrosis scores has been depicted in Figure 3. The sensitivity was 84.44% and Specificity was 80.53%. The correlation between the necrosis score in the CT severity index and serum CRP values was also determined. The duration of hospital admission was recorded as a marker of disease morbidity. A significant cutoff value of 100 mg/dl was used for CRP, although different studies cited in this research suggested different significant values (100 mg/dl and 150 mg/dl). <strong>Conclusion:</strong> Elevated CRP values beyond the significant range positively correlate with the occurrence of necrosis in pancreatitis. This information can aid in deciding which patients require a contrast-enhanced CT scan (CECT), considering that this investigation is both expensive and not readily accessible.
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Chooklin, S., B. Pidhirnyi, and R. Barylyak. "Soluble Fibrin-monomeric Complexes and D-dimers as Indicators of Acute Pancreatitis Severity." Lviv clinical bulletin 3-4, no. 39-40 (2023): 26–32. http://dx.doi.org/10.25040/lkv2022.03-04.026.
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Introduction. Local and systemic inflammation, disorders in the hemostatic system are among the key components of acute pancreatitis (AP) pathogenesis already in its early stages, and in future development of thrombohemorrhagic complications. The degree of systemic hemostatic disorders in AP varies from subclinical activation of coagulation, which can only be detected using sensitive markers of activation of coagulation factors, to fulminant disseminated intravascular coagulation syndrome, characterized by multiple systemic microvascular thrombosis and profuse bleeding from different sites. It has been proven that D-dimers and soluble fibrin-monomeric complexes (SFMK) are valuable markers of coagulation and fibrinolysis activation. The aim of the study. To study the dynamics of D-dimers, soluble fibrin-monomeric complexes in the blood of patients with acute pancreatitis, depending on the severity of the disease. Materials and methods. A prospective examination of 206 patients with AP was carried out. According to the criteria of the International Classification, mild pancreatitis was verified in 51 patients, moderate – in 98, severe – in 57. The concentration of SFMK, D-dimers was determined in 66 patients with AP on the first, third, seventh and fourteenth days of conservative treatment. The reference values were estimated in 11 healthy individuals. Results. The enhansed concentration of SFMK and D-dimers were detected in the blood of all patients under examination. Their content directly correlated with the severity of AP course as determined by the Ranson and BISAP score, the severity of the patient’s condition by the APACHE II score and organ dysfunction by the SOFA score, and the degree of damage to the pancreas by the Balthazar criteria. The concentration of SFMK and D-dimers significantly increased with the occurrence of respiratory, cardiovascular, renal, and metabolic dysfunction. A reliable direct correlation was determined between the amount of SFMK and the concentration of creatinine and glucose in the blood of patients with AP. The increase in the level of D-dimers significantly directly correlated with the concentration of creatinine in the blood serum. The sensitivity of SFMK determination (cut-of value 137.50 ng/L) for predicting pulmonary dysfunction was 86.20 %, and the specificity was 83.80 %, with positive and negative predictive values of 80.65 and 88.57 % respectively. Conclusions. The course of acute pancreatitis is accompanied by local or systemic inflammation, changes in the hemostatic system, severity of which correlating with the severity of the disease. Characteristic feature for patients with severe acute pancreatitis is the combination of systemic inflammation with procoagulant changes. The severity of acute pancreatitis, the severity of patient’s condition and organ dysfunction, the severity of pancreatic lesions are associated with an increase of fibrin degradation products. The concentration of soluble fibrin-monomeric complexes can be used to predict pulmonary dysfunction in patients with acute pancreatitis.
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Korymasov, E. A., and M. Yu Khoroshilov. "”Fulminant” acute pancreatitis: diagnosis, prognosis, treatment." Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery 26, no. 2 (2021): 50–59. http://dx.doi.org/10.16931/10.16931/1995-5464.2021-2-50-60.
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Aim: improving the results treatment of patients with severe acute pancreatitis by early diagnosis fulminant course of the disease and development of individualized treatment tactics based on early surgical interventions with perioperative extracorporeal detoxificationMaterials and methods: In research analyzed the treatment of 232 patients with severe acute pancreatitis: 175 patients were evaluated retrospectively (control group), 57 were included in a prospective study (main group). The severity of the disease was studied using integral scales, necrosis of the pancreas (its localization, depth) and the prevalence of parapancreatitis (gradations according to Ishikawa et al.) - according to CT data. The tactics of treatment at the retrospective stage of the study was based on the current Clinical Recommendations, at the prospective stage - on the developed signs of a "fulminant" course of the disease and included early operations with perioperative extracorporeal detoxification.Results: Criteria for a fulminant course of severe acute pancreatitis were found in 41 (23%) of 175 and 24 (42%) of 57 patients. According to the scale values (APACHE II ≥ 16 Ranson ≥ 8, SOFA ≥ 7 points) in the first 48 hours from the onset of the disease, the presence of aseptic enzymatic peritonitis, the depth of necrosis in the region of the head and body of the pancreas ≥50%, intra-abdominal hypertension of the III-IV degree, significant differences with similar indicators in 134 and 33 patients with severe acute pancreatitis. With fulminant course in the control and main groups, all 5 patients who received only conservative treatment died, 33 (86.8%) and 9 (40.9%) after operations, χ2 = 13.32, p<0.001. Mortality in severe acute pancreatitis, excluding patients with fulminant course, was comparable in the groups, being 15.7% and 15.2%, χ2 = 0.450, p> 0.05.Conclusion: Patients with severe acute pancreatitis represent a heterogeneous group. The morphological substrate of "fulminant" pancreatitis is deep (more than 50%) necrosis with localization in the head and body of the pancreas and widespread parapancreatitis. The developed individualized approach to treatment allows predicting an unfavorable course in the first 48 hours after the onset of the disease. Early operations in the nature of detoxification, decompression and drainage interventions, with perioperative use of extracorporeal detoxification methods allowed to reduce mortality from 86.8% to 40.9%.
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Zezekalo, E. O., M. O. Dudchenko, M. I. Kravtsiv, et al. "CONTEMPORARY PERSPECTIVES ON DIAGNOSING ACUTE PANCREATITIS." Актуальні проблеми сучасної медицини: Вісник Української медичної стоматологічної академії 23, no. 4 (2023): 105–9. http://dx.doi.org/10.31718/2077-1096.23.4.105.
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Acute pancreatitis represents a significant challenge in urgent surgery. It holds a prominent position among urgent surgical diseases, with a rising incidence of severe, complicated forms. The increase in the negative outcomes of acute pancreatitis treatment is linked to delayed diagnosis of severe forms and their complications, owing to the absence of a highly effective severity assessment scale. This deficiency contributes to unjustified surgical interventions. Early severe pancreatitis manifests with a rapidly progressive course leading to organ failure, hypoxia, necrotic foci formation, abdominal sepsis, and abdominal compartment syndrome. Specific scales for early diagnosis include the criteria scale for primary assessment of acute pancreatitis severity, the Ranson scale, and the BISAP scale. The modern diagnosis of severe acute pancreatitis relies on two key international classifications: the Revised Atlanta Classification (2012) and the Determinant-based classification (2012). To assess the intensity of pancreatic inflammation by CT scan, the Balthazar scale is used, which is included in the Computer Tomography Severity Index and enables to determine the area of pancreatic necrosis.
 The purpose of this study is to improve the diagnosis of acute severe pancreatitis.
 The study was carried out by assessing the medical records of 20 patients diagnosed with acute pancreatitis who received treatment at the Surgical Inpatient Department of the 2nd City Hospital, Poltava, from 2021 to 2022.
 The analysis revealed that conducting a computer tomography within the 48-72 hours from the onset of the disease enables a comprehensive assessment of its severity. This assessment significantly influences the subsequent treatment approach, reducing the necessity for surgical intervention and lowering the risk of patient mortality.
 Hence, in alignment with contemporary classifications and diagnostic perspectives on acute pancreatitis, MSCT assumes a pivotal role, significantly influencing the selection of treatment strategies in all cases. This inclusion facilitates timely surgical interventions and allows for adjustments to conservative therapy based on the severity of pancreatic inflammation. It is advisable, however, to conduct computed tomography 48-72 hours after the onset of pain to adequately assess the pancreatic condition. Morphological changes in the pancreas typically do not manifest within the initial day of the disease, making early CT diagnostics potentially misleading regarding the true state and severity of acute pancreatitis.
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Feng, Xueqin, and Yian-Kui Liu. "Measurability criteria for fuzzy random vectors." Fuzzy Optimization and Decision Making 5, no. 3 (2006): 245–53. http://dx.doi.org/10.1007/s10700-006-0013-0.
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