Arnell et al identified risk factors associated with complications in patients with gallstone pancreatitis. These can help identify a patient on admission who should be monitored in the intensive care unit (ICU). The authors are from Harbor-UCLA Medical Center in Torrance California.
Patient selection: gallstone pancreatitis (most were relatively young Hispanic women)
Outcomes requiring ICU care (one or more organ failures):
(1) respiratory failure with mechanical ventilation
(2) hypotension, cardiac ischemia, myocardial infarction or significant arrhythmia
(3) renal failure
(4) DIC or severe thrombocytopenia
(5) Glasgow coma score < 9
(6) GI bleeding requiring > 2 units pRBCs in 24 hours
(7) sepsis or pancreatic abscess
Admission parameters:
(1) white blood cell count
(2) glucose
(3) urea (the authors refer to this as BUN, but use units of mmol/L; see chapter on unit conversion)
(4) pulse
(5) APACHE II
|
Parameter |
Finding |
Points |
|
WBC count |
< 14,500 per µL |
0 |
|
|
>= 14,500 per µL |
1 |
|
glucose |
< 150 mg/dL |
0 |
|
|
>= 150 mg/dL |
1 |
|
urea |
< 12 mmol/L |
0 |
|
|
>=12 mmol/L |
1 |
|
pulse |
< 100 beats per minute |
0 |
|
|
>= 100 beats per minute |
1 |
|
APACHE II |
< 5 |
0 |
|
|
>= 5 |
1 |
number of risk factors =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The more risk factors the greater the risk for complications.
• The presence of 3 or more risk factors is associated with a high risk for complications.
Performance:
• Individual risk factors show sensitivities from 71 to 86% and specificities from 78 to 87%.
• For >= 3 risk factors the sensitivity was 71% and specificity 97% (specific but somewhat insensitive).
Specialty: Gastroenterology
