Johnson et al reported predictors for mortality in a patient with severe acute pancreatitis. These can help to identify a patient who may benefit from more aggressive management. The authors are from the British Acute Pancreatitis Study Group.
Patient selection: severe acute pancreatitis (APACHE II score > 6), ages from > 18 to < 80 years of age
Criteria for organ failure:
(1) systolic blood pressure <= 90 mm Hg after fluid replacement (cardiovascular)
(2) PaO2/FIO2 ratio < 300 mm Hg (respiratory)
(3) Glasgow coma score < 13 (neurologic)
(4) platelet count <= 80 * 10^9/L (coagulation)
(5) plasma creatinine > 170 µmol/L (renal)
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Duration of Organ Failure
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Term
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less than 3 consecutive days, excluding day 0
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transient
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>= 3 consecutive days, excluding day 0
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persistent
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Risk factors for mortality:
(1) APACHE II score in the first 24 hours > 8
(2) persistent organ failure
Persistent organ failure was also associated with local complications (pancreatic necrosis; pseudocyst).
