Search for prognostic markers for acute pancreatitis

Abstract

The clinician is poor at predicting the severity of acute pancreatitis at the bedside. 1 Wilson C Heath D Imrie C Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg. 1990; 77: 1260-1264 Crossref PubMed Scopus (415) Google Scholar Consequently there are numerous markers of severity, which have been based on the notion that early prediction improves clinical outcome. There is some evidence for the value of accurately identifying the patient who has or will develop severe pancreatitis in that some patients with severe pancreatitis will benefit from prophylactic antibiotics, 2 Johnson C Antibiotic prophylaxis in severe acute pancreatitis. Br J Surg. 1996; 83: 883-884 Crossref PubMed Scopus (36) Google Scholar enteral nutrition, 3 Windsor A Kanwar S Li A et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut. 1998; 42: 431-435 Crossref PubMed Scopus (615) Google Scholar and early endoscopic retrograde cholangio-pancreatography. 4 Fan S Lai E Mok F Lo C Zheng S Wong J Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med. 1993; 328: 228-232 Crossref PubMed Scopus (719) Google Scholar Other reasons for the early prediction of severity of pancreatitis are to identify patients who might benefit from transfer to a specialist centre, to select patients for clinical trials, and to compare results between centres. Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre studyUrinary TAP provided accurate severity prediction 24 h after onset of symptoms. This single marker of severity in acute pancreatitis deserves routine clinical application. Full-Text PDF