### Description

Leese et al identified risk factors associated with severe disease in patients with acute pancreatitis. These can help identify a person at increased risk for whom additional studies such as contrast enhanced CT may be indicated. The authors are from the University of Leicester in England.

Parameters:

(1) Imrie (Glasgow) prognostic score, on admission

(2) C-reactive protein (CRP) on day 3 after admission, using radial imunodiffusion with a normal range < 0.01 g/L (see Figure 1, page 230)

(3) white blood cell count on day 7 after admission

 Parameter Finding Points Imrie prognostic score on admission 0 – 2 0 3 - 9 1 CRP on day 3 <= 0.15 g/L 0 > 0.15 g/L 1 WBC count on day 7 <= 15 * 10^9/L (<= 15,000 per µL) 0 > 15 * 10^9/L (> 15,000 per µL) 1

number of risk factors present =

= SUM(points for the 3 parameters)

 Number of Risk Factors Sensitivity for Severe Disease Specificity for Severe Disease 1 95% 52% 2 65% 83% 3 35% 98%

On page 231, the authors give the following equations for probability of severe outcome:

probability of severe outcome =

= EXP(X) / (1 + EXP(X))

X for day 1 =

= (0.62827 * (initial Imrie score)) + (0.07055 * (initial WBC count)) – 4.2396

X for day 3 =

= (0.82702 * (on day 3 Imrie score)) + (7.3241 * (CRP on day 3)) – 4.8940

X for day 7 =

= (0.65979 * (on day 7 Imrie score)) + (0.15617 * (WBC count on day 7)) – 4.9089

where:

• I assume that WBC count used is the (value) * 10^9.

Limitations:

• The cutoff point for CRP will probably need to be adjusted for different analytic methods.