From the Guidelines
Patients with acute pancreatitis should be admitted to the hospital if they have severe disease, persistent organ failure, or signs of systemic inflammatory response syndrome, as these conditions are associated with high mortality and morbidity 1. When considering admission for acute pancreatitis, several factors should be taken into account, including:
- Severity of disease, as classified by the Revised Atlanta Classification or Determinant-based Classification of Acute Pancreatitis Severity 1
- Presence of persistent organ failure, such as cardiovascular, respiratory, or renal failure 1
- Signs of systemic inflammatory response syndrome, including temperature >38°C or <36°C, heart rate >90 beats/minute, respiratory rate >20 breaths/minute, white blood cell count >12,000/mm³ or <4,000/mm³ 1
- Elevated blood urea nitrogen (>20 mg/dL) or impaired mental status 1
- Presence of comorbidities that increase risk of complications, such as cardiovascular or renal disease 1
- Ranson score ≥3, APACHE II score ≥8, or BISAP score ≥3, which indicate a higher risk of severe disease 1 Initial management of acute pancreatitis includes aggressive intravenous fluid resuscitation, adequate pain control, and nothing by mouth status until pain improves and nausea resolves 1. However, recent evidence suggests that aggressive intravenous hydration may not be beneficial for all patients with acute pancreatitis, and may even increase the risk of fluid overload and mortality in patients with non-severe disease 1. Therefore, admission and treatment should be individualized based on the severity of disease and the presence of comorbidities, with a focus on preventing complications and improving outcomes 1.
From the Research
Admission Criteria for Acute Pancreatitis
When considering admission for a patient with acute pancreatitis, several factors should be taken into account. These include:
- The severity of the condition, as patients with severe acute pancreatitis require intensive care and monitoring 2
- The presence of systemic inflammatory response syndrome on day 1 of hospital admission, which is highly sensitive in predicting severe disease 3
- The need for goal-directed fluid resuscitation, analgesics, and oral feedings as tolerated on admission 3
- The presence of complications such as pancreatic necrosis, organ failure, or cholangitis, which may require prolonged hospitalization, intensive care, and radiologic, surgical, and/or endoscopic intervention 4
Severity Assessment and Scoring Systems
Severity assessment should be conducted repeatedly, at least within 48 hours following diagnosis, as the disease condition in acute pancreatitis can change rapidly 2. Several scoring systems, including the Ranson score and the APACHE III score, can be used to predict disease severity and outcomes 5. The Ranson score is still the most popular method for gauging the severity of pancreatitis and more accurately predicts outcomes in patients with severe acute pancreatitis when compared with APACHE III scores 5.
Special Considerations
Patients with chronic kidney disease (CKD) are at higher risk of developing acute pancreatitis, and rigorous monitoring of electrolytes is mandatory for managing CKD patients with acute pancreatitis 6. In patients with severe acute pancreatitis, prophylactic antibiotic administration is recommended to prevent infectious complications, and enteral feeding is superior to parenteral nutrition for nutritional support 2.