Severity Assessment Of Acute Pancreatitis Research Articles

New Insights into Pathogenesis, Diagnosis, and Treatment of Pancreatic Disorders

New Insights into Pathogenesis, Diagnosis, and Treatment of Pancreatic Disorders

Early Detection of Low Enhanced Pancreatic Parenchyma by Contrast-Enhanced Computed Tomography Predicts Poor Prognosis of Patients With Acute Pancreatitis

The usefulness of early severity assessment of acute pancreatitis (AP) by contrast-enhanced computed tomography (CECT) was investigated. Data were obtained from a 2007 nationwide survey in Japan. Clinical data of 983 patients with AP were analyzed. All were examined by CECT on the day of admission. Early findings of CECT demonstrated that low enhanced pancreatic parenchyma (LEPP) was associated with the incidence of organ failure (OF), multiple OF, and infectious complications as well as mortality (P < 0.0001). Next, patients were further divided into 4 groups according to the CECT findings, which focused on the LEPP and peripancreatic collections (PPCs). The LEPP/PPC (+/+) group was characterized as high morbidity and high mortality. The incidence of OF (28.2%), multiple OF (15.5%), and mortality (11.4%) in patients assigned to the (+/+) group was significantly higher than in those assigned to the other groups. The incidence of infectious complications was significantly higher in patients assigned to the (+/+) group (16.7%), the (+/-) group (9.0%), and the (-/+) group (7.0%) than those assigned to the (-/-) group (1.8%). The detection of LEPP and PPC was a useful CECT finding for the early assessment of the severity of AP.

Blood urea nitrogen levels predict mortality risk in acute pancreatitis

Acute pancreatitis is associated with high hospitalization rates, and ≤20% of hospitalized patients develop a life-threatening form of the disease that requires intensive care, typically within 24–48 h of admission. For this reason, early identification of these high-risk patients is vital. Bechien Wu and colleagues now report that serial measurements of blood urea nitrogen (BUN) levels provide an accurate assessment of acute pancreatitis severity and are a good predictor of clinical outcome and mortality risk.

重症度判定基準(2008)による重症急性膵炎症例の再検討

重症度判定基準(2008)による重症急性膵炎症例の再検討

Validation of the New Severity Assessment Criteria for Acute Pancreatitis

The Japanese criteria for the severity assessment of acute pancreatitis were revised. To validate the new severity assessment criteria (new criteria) from the aspect of the clinical course, we categorized patients into 4 groups: patients considered severe by both the heretofore used criteria (previous criteria) and the new criteria, severe group; patients considered severe only by the previous criteria, previous severe group; patients considered severe only by the new criteria, new severe group; and patients considered not severe by both the previous and new criteria, mild group. In each group, the clinical outcomes such as the days to normalization of the serum C-reactive protein, the days to resumption of oral diet, and total hospital stay were investigated. As a result, while no significant differences were observed in the clinical outcomes between the previous severe group and mild group, there were significant differences between the previous severe group and severe group. On the other hand, while no significant differences were observed in the clinical outcomes between the new severe group and severe group, there were significant differences between the new severe group and mild group. These results suggest that the new criteria are pertinent for assessing the severity of acute pancreatitis from the aspect of the clinical course compared with the previous criteria.

3. Diagnosis and Severity Assessment of Acute Pancreatitis.

3. Diagnosis and Severity Assessment of Acute Pancreatitis.

Cutting‐edge information for the management of acute pancreatitis

Considering that the Japanese (JPN) guidelines for the management of acute pancreatitis were published in Takada et al. (J HepatoBiliary Pancreat Surg 13:2-6, 2006), doubts will be cast as to the reason for publishing a revised edition of the Guidelines for the management of acute pancreatitis: the JPN guidelines 2010, at this time. The rationale for this is that new criteria for the severity assessment of acute pancreatitis were made public on the basis of a summary of activities and reports of shared studies that were conducted in 2008. The new severity classification is entirely different from that adopted in the 2006 guidelines. A drastic revision was made in the new criteria. For example, about half of the cases that have been assessed previously as being 'severe' are assessed as being 'mild' in the new criteria. The JPN guidelines 2010 are published so that consistency between the criteria for severity assessment in the first edition and the new criteria will be maintained. In the new criteria, severity assessment can be made only by calculating the 9 scored prognostic factors. Severity assessment according to the contrast-enhanced computed tomography (CT) grade was made by scoring the poorly visualized pancreatic area in addition to determining the degree of extrapancreatic progress of inflammation and its extent. Changes made in accordance with the new criteria are seen in various parts of the guidelines. In the present revised edition, post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is treated as an independent item. Furthermore, clinical indicators (pancreatitis bundles) are presented to improve the quality of the management of acute pancreatitis and to increase adherence to new guidelines.

Assessment of severity of acute pancreatitis according to new prognostic factors and CT grading

The assessment of severity at the initial medical examination plays an important role in introducing adequate early treatment and the transfer of patients to a medical facility that can cope with severe acute pancreatitis. Under these circumstances, "criteria for severity assessment" have been prepared in various countries, including Japan, and these criteria are now being evaluated. The criteria for severity assessment of acute pancreatitis in Japan were determined in 1990 (of which a partial revision was made in 1999). In 2008, an overall revision was made and the new Japanese criteria for severity assessment of acute pancreatitis were prepared. In the new criteria for severity assessment, the diagnosis of severe acute pancreatitis can be made according to 9 prognostic factors and/or the computed tomography (CT) grades based on contrast-enhanced CT. Patients with severe acute pancreatitis are expected to be transferred to a specialist medical center or to an intensive care unit to receive adequate treatment there. In Japan, severe acute pancreatitis is recognized as being a specified intractable disease on the basis of these criteria, so medical expenses associated with severe acute pancreatitis are covered by Government payment.

急性膵炎重症度判定基準―造影CT Grade―

急性膵炎重症度判定基準―造影CT Grade―

JPN Guidelines for the management of acute pancreatitis: severity assessment of acute pancreatitis

This article addresses the criteria for severity assessment and the severity scoring system of the Ministry of Health and Welfare of Japan; now the Japanese Ministry of Health, Labour, and Welfare (the JPN score). It also presents data comparing the JPN score with the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Ranson score, which are the major measuring scales used in the United States and Europe. The goal of investigating these scoring systems is the achievement of earlier diagnosis and more appropriate and successful treatment of severe or moderate acute pancreatitis, which has a high mortality rate. This article makes the following recommendations in terms of assessing the severity of acute pancreatitis:(1) Severity assessment is indispensable to the selection of proper initial treatment in the management of acute pancreatitis (Recommendation A).(2) Assessment by a severity scoring system (JPN score, APACHE II score) is important for determining treatment policy and identifying the need for transfer to a specialist unit (Recommendation A).(3) C-reactive protein (CRP) is a useful indicator for assessing severity (Recommendation A).(4) Contrast-enhanced computed tomography (CT) scanning and contrast-enhanced magnetic resonance imaging (MRI) play an important role in severity assessment (Recommendation A).(5) A JPN score of 2 or more (severe acute pancreatitis) has been established as the criterion for hospital transfer (Recommendation A).(6) It is preferable to transfer patients with severe acute pancreatitis to a specialist medical institution where they can receive continuous monitoring and systemic management.

A new scoring system for the assessment of acute pancreatitis severity

A new scoring system for the assessment of acute pancreatitis severity

Prognostic factors in acute pancreatitis.

The assessment of the severity of acute pancreatitis (AP) is a critical early step in its management, as severity of AP predicts prognosis. A range of options are available for assessment of severity in AP, including clinical evaluation, standardized prognostic criteria, computed tomography (CT), and biochemical markers. Clinical assessment has limited accuracy for predicting severity early in the course of AP. Therefore, additional assessment using biochemical and radiologic criteria in combination with standardized criteria is appropriate to determine severity and prognosis in AP; a strategy emphasizing daily assessment of severity should be used. The APACHE II is the scoring system of choice for evaluating severity in AP, although it remains an imperfect tool. Computed tomographic grading of AP and the development of the CT severity index allow for heightened accuracy in the prediction of severity. C-Reactive protein is the standard for serum marker assessment of severity and prognosis in AP; other markers, including interleukin-6, polymorphonuclear elastase, and trypsinogen activation peptide, hold promise. The focus of this review is to examine the role of diagnostic tests in evaluating severity and predicting prognosis among patients with AP and to provide a diagnostic algorithm for initial management.