From the Guidelines
To assess for worsening acute pancreatitis, monitor for persistent organ failure, signs of infected necrosis, and worsening laboratory markers, as these are associated with high mortality and morbidity, as stated in the 2019 WSES guidelines 1. When evaluating patients with acute pancreatitis, it is crucial to track laboratory markers, including serum amylase and lipase levels, which should be three times the upper limit to indicate pancreatitis 1.
- Other key laboratory parameters to monitor include:
- C-reactive Protein (CRP) level ≥ 150 mg/l at the third day, which can be used as a prognostic factor for severe acute pancreatitis 1
- Hematocrit > 44%, representing an independent risk factor of pancreatic necrosis 1
- Urea > 20 mg/dl, which is an independent predictor of mortality 1
- Procalcitonin, the most sensitive laboratory test for detection of pancreatic infection, with low serum values appearing to be strong negative predictors of infected necrosis 1
- Clinically, watch for signs of systemic inflammatory response syndrome (SIRS), development of local complications (peritoneal signs), respiratory distress, and decreased urine output, as these can indicate worsening pancreatitis.
- The Revised Atlanta Classification and scoring systems like APACHE II, Ranson's criteria, or BISAP score can help quantify severity, as mentioned in the guidelines 1.
- Serial imaging with CT or ultrasound can identify complications like necrosis, pseudocysts, or fluid collections, allowing for timely escalation of care, including possible ICU transfer if organ support becomes necessary.
- Early recognition of deterioration is crucial, as mortality increases significantly with organ failure persisting beyond 48 hours, emphasizing the need for frequent assessments in the first 72 hours 1.
From the Research
Criteria for Assessing Worsening Acute Pancreatitis
The following criteria are used to assess worsening acute pancreatitis:
- Presence of systemic inflammatory response syndrome on day 1 of hospital admission, which is highly sensitive in predicting severe disease 2
- Revised Atlanta classification, which diagnoses acute pancreatitis based on the presence of at least two of three criteria: upper abdominal pain, serum amylase or lipase level greater than three times the upper limit of normal, or characteristic findings on imaging studies 2
- Scoring systems such as the Bedside Index for Severity in Acute Pancreatitis score, and the American Association for the Surgery of Trauma grade, which have been devised to classify and predict the development of severe acute pancreatitis 3
- CT severity index, modified severity index, and revised Atlanta classification, which are used to assess the extent of acute pancreatitis and evaluate complications 4
Clinical Parameters for Assessing Worsening Acute Pancreatitis
The following clinical parameters are used to assess worsening acute pancreatitis:
- Length of hospital stay
- Need for surgery or percutaneous intervention
- Evidence of infection in any organ system
- Occurrence of organ failure, including respiratory, cardiovascular, renal, hepatic, and hematological system failure
- Death 4
Imaging Studies for Assessing Worsening Acute Pancreatitis
Imaging studies such as computed tomography (CT) are used to assess the extent of acute pancreatitis and evaluate complications, including: