What is the severity of pancreatitis (inflammation of the pancreas)?

From the Guidelines

Pancreatitis severity is best quantified using the Revised Atlanta Classification, which categorizes pancreatitis as mild, moderately severe, or severe based on organ failure and local/systemic complications. This classification system is supported by recent studies, including the 2019 WSES guidelines for the management of severe acute pancreatitis 1. The Revised Atlanta Classification is a widely accepted and evidence-based system that accurately reflects clinical outcomes and is superior to older classification systems, such as the 1992 Atlanta Classification.

Key features of the Revised Atlanta Classification include:

• Mild pancreatitis: no organ failure, local or systemic complications
• Moderately severe pancreatitis: transient (less than 48 h) organ failure, local complications or exacerbation of co-morbid disease
• Severe pancreatitis: persistent (more than 48 h) organ failure The use of this classification system allows for early severity assessment, which is crucial for appropriate triage and management of patients with pancreatitis. Patients with severe pancreatitis require intensive monitoring, aggressive fluid resuscitation, and consideration for transfer to specialized centers with multidisciplinary expertise in managing complications 1.

Other scoring systems, such as BISAP, Ranson's criteria, and APACHE II, can also be used to quantify pancreatitis severity, but the Revised Atlanta Classification is currently the most widely accepted and evidence-based system. Laboratory markers, such as C-reactive protein >150 mg/L at 48 hours, and persistent organ failure (>48 hours) also indicate severe disease 1.

In clinical practice, it is essential to use a combination of these classification systems and laboratory markers to accurately assess pancreatitis severity and provide optimal patient care. The Revised Atlanta Classification provides a clear and concise framework for categorizing pancreatitis severity, which can help guide treatment decisions and improve patient outcomes 1.

From the Research

Pancreatitis Severity Quantification

• Pancreatitis severity can be quantified using various scoring systems, including the Bedside Index of Severity in Acute Pancreatitis (BISAP) and the Acute Physiology and Chronic Health Evaluation (APACHE) II tools 2, 3.
• These scoring systems have good predictive capabilities for disease severity and mortality, but no one tool works well for all forms of acute pancreatitis 2.
• The BISAP score is a simple scoring system that can be used at admission to predict the severity of pancreatitis, and it has been shown to be as good as APACHE-II but better than Ranson criteria, CT severity index (CTSI), C-reactive protein (CRP), hematocrit, and body mass index (BMI) 4.
• Other scoring systems, such as Ranson's and CTSI, have also been used to predict severity, pancreatic necrosis, and mortality in acute pancreatitis, but their predictive accuracy may vary 5.
• In chronic pancreatitis, there are no globally accepted classification or severity scores to predict the disease course or compare interventions, and available systems and scores do not reflect recent advances and guidelines in chronic pancreatitis 6.

Scoring Systems

• BISAP score: includes blood urea nitrogen >25 mg/dl, impaired mental status, systemic inflammatory response syndrome (SIRS), age >60 years, and pleural effusions 4, 5.
• APACHE-II score: a multifactorial scoring system that includes various physiological and laboratory parameters 2, 5.
• Ranson's score: a multifactorial scoring system that includes various physiological and laboratory parameters, such as age, white blood cell count, and blood glucose 3, 5.
• CTSI: a scoring system that uses computed tomography imaging to predict the severity of pancreatitis 3, 5.

Predictive Accuracy

• The predictive accuracy of scoring systems can be measured by the area under the receiver-operating curve (AUC) 4, 5.
• The AUC for BISAP, Ranson's, APACHE-II, and CTSI in predicting severe acute pancreatitis and mortality has been reported to be around 0.8-0.9 4, 5.
• The predictive accuracy of scoring systems may vary depending on the population and the specific outcome being predicted 2, 3.