Criteria for severe acute pancreatitis - one or more of the following:
(1) Ranson score on admission >= 3 (or during the first 48 hours)
(2) APACHE II score >= 8 at any time during course
(3) presence of one or more organ failures
(4) presence of one or more local complications
Organ failures include:
(1) shock (systolic blood pressure less than 90 mm Hg)
(2) pulmonary insufficiency (PaO2 <= 60 mm Hg on room air)
(3) renal failure (serum creatinine > 2 mg/dL after fluid replacement)
(4) gastrointestinal bleeding, with > 500 mL estimated loss within 24 hours
(5) DIC (thrombocytopenia and hypofibrinogenemia and fibrin split products)
(6) severe hypocalemia (<= 7.5 mg/dL)
Local complications include:
(1) pancreatic necrosis
(2) pancreatic abscess
(3) pancreatic pseudocyst
