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Prognostic Scores of Clavien et al for Evaluating a Patient with Acute Pancreatitis

Purpose: To evaluate a patient with acute pancreatitis using the prognostic scores of Clavien et al.

Description

Clavien et al developed several scores for evaluating the prognosis for a patient with acute pancreatitis. This can help identify patients with acute pancreatitis who may require more aggressive management. The authors are from the University of Geneva in Switzerland.


Scores:

(1) findings on admission (modified from criteria of Ranson et al)

(2) findings during first 48 hours after admission (modified from criteria of Ranson et al)

(3) grade for CT findings

 

Parameters for score on admission:

(1) age in years and gender

(2) WBC count

(3) blood glucose

 

Parameter on Admission

Finding

Points

age in years and gender

male and <= 55 years

0

 

male and > 55 years

1

 

female and <= 60 years

0

 

female and > 60 years

1

WBC count

<= 16,000 per µL

0

 

> 16,000 per µL

1

blood glucose

<= 11.1 mmol/L

0

 

> 11.1 mmol/L (200 mg/dL)

1

 

Parameters for first 48 hours after admission:

(1) clinical signs of peritonitis (tenderness, guarding, rebound tenderness)

(2) change in hematocrit

(3) change in BUN

(4) serum calcium

(5) PaO2

(6) base deficit

(7) fluid sequestration

 

Parameter During 48 Hours

Finding

Points

clinical peritonitis

absent

0

 

present

1

change in hematocrit

not decreased by > 10%

0

 

decrease by > 10%

1

change in BUN

not increased by > 5 mg/dL

0

 

increased by > 5 mg/dL

1

serum calcium

>= 2 mmol/L

0

 

< 2 mmol/L

1

PaO2

>= 60 mm Hg

0

 

< 60 mm Hg

1

base deficit

<= 4 mmol/L

0

 

> 4 mmol/L

1

fluid sequestration

<= 6 liters

0

 

> 6 liters

1

 

total points =

= (points on admission) + (points during first 48 hours)

 

Total Points

Clinical Score

0 or 1

1

2 to 4

2

5 to 10

3

 

 

Extrapancreatic Phlegmon on CT Scan

CT Grade

none

I

1 or 2 areas

II

>= 3 areas

III

 

 

Clinical Score

CT Grade

Mortality Rate

1

I, II or III

very low

2 or 3

I

very low

2 or 3

II

low to moderate

2

III

moderate

3

III

high

from Figures 6 and 7, page 462


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Specialty

Objective

ICD-10