Prognostic Markers

For most patients, acute pancreatitis is a self-limited disease, but 5 to 10 percent suffer from significant associated morbidity and mortality. -I4 It can be difficult to identify patients at risk, although signs of a systemic response suggest a more complicated course. Ranson has identified multiple diagnostic criteria used to predict patient outcome (T§b]§..83i4)15 The number of factors present is then used to predict mortality. Patients with fewer than three criteria have a 1 percent mortality, those with three to four criteria have a 16 percent mortality, those with five to six criteria have a 40 percent mortality, and those with more than six criteria have 100 percent mortality. Although the presence of several risk factors in the emergency department portends a worse prognosis, the Ranson criteria require an assessment of clinical values within the first 48 h of hospitalization and therefore have limited utility in the initial evaluation. Other scoring systems have been used to predict severity in pancreatitis, such as the acute physiology and chronic health evaluation (APACHE II) score, but complexity and poor sensitivity on initial presentation limit their role in the emergency department.1 In general, the presence of extraabdominal complications or comorbid conditions indicates an increased mortality risk. Hypotension, tachycardia of more than 130 bpm, a Po2 of less than 60 mmHg, oliguria, increasing blood urea nitrogen or creatinine, and hypocalcemia are key indicators of a potentially complicated course.13!5

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