Severity Grading/Prognostic Scores

The revised Atlanta grades of severity classify pancreatitis as mild, moderate, or severe, depending on the presence of organ failure. Organ failure can be determined using the modified Marshall scoring system for organ dysfunction.

• Mild acute pancreatitis: no organ failure and no local or systemic complications

• Moderate acute pancreatitis: transient organ failure (< 48 hours) and/or local or systemic complications

• Severe acute pancreatitis: persistent organ failure (> 48 hours)

Patients with organ failure at presentation or within the first 24 hours of admission should be classified as having severe pancreatitis. If organ failure resolves within 48 hours, patients can be reclassified as having moderately severe acute pancreatitis.

The CT severity index for acute pancreatitis (CTSI) and modified CT severity index (MCTSI) can be used to estimate the severity, mortality, and morbidity of acute pancreatitis based on the extent of pancreatic inflammation and necrosis on a CT abdomen performed ideally > 5–7 days (or at least 72 hours) after symptom onset.

The Ranson criteria is one of the oldest predictive models used to estimate severity and prognosis of biliary and nonbiliary pancreatitis, but full assessment is only possible after 48 hours, and sensitivity for predicting severity and outcome can be as low as 70%.

• Used to estimate in-hospital mortality due to pancreatitis

• Each criterion is worth one point.

  • BUN > 8.9 mmol/L

  • Altered mental status

  • Presence of SIRS

  • Age > 60 years

  • Pleural effusion on chest x-ray

• BISAP ≥ 2 indicates severe pancreatitis.