Assessment of the severity of acute destructive pancreatitis for proper treatment selection

Abstract

The review covers the most common integrated scales used for the assessment of severity of acute destructive pancreatitis. The use of those scales in the surgical in-patient department is discussed. Different views of Russian and foreign pancreatologists on the use of integrated scales to predict the disease outcome according to various criteria (clinical, laboratory, and special examination methods) are presented. Because of the acute pancreatitis morphological forms variety at admission for urgent surgery, there is a need for a comprehensive assessment of the disease severity in such patients. First stage of assessment is based on clinical data obtained at admission; correlation with systemic organ failure is also taken into account. This approach helps to distinguish mild, moderate and severe clinical course of disease. The use of multiple integral scales used for clinical assessment, with the number of possible options exceeding 20, is widely applied when the patient is admitted. The surgeon’s selection of a scale for assessment of the disease severity depends on the available equipment and the time for evaluation. Currently, the multi-parameter prognostic scales Ranson (1972), APACHE II (Acute Physiology And Chronic Health Evaluation, 1990), Glasgow-Imrie (1984), SAPS (Simplified acute physiology score, 1984), MODS (Multiple Organ Dysfunction Score, 1995), SOFA (Sepsis-related Organ Failure. 1996) are considered to be most objective. The use of these scales allows improving the prediction of outcome and necrotic complications by several times.