Predictors of severity and necrosis in acute pancreatitis

The clinical course of acute pancreatitis varies from a few hours of mild epigastric discomfort to prolonged intensive care unit stays or death. Advances in supportive care can limit the severity of complications in patients who are developing a more severe course, but these are unnecessary in patients with mild disease. This article reviews the methods used to provide early prognostication of the severity of cases of acute pancreatitis. The accuracy of the Ranson's, Glasgow, Acute Physiology and Chronic Health Evaluation (APACHE) II and other scoring systems; markers of inflammation (eg, interleukin [IL]-1, IL-6, IL-8, tumor necrosis factor, C-reactive protein); or markers of zymogen activation (carboxypeptidase B activation peptide, trypsinogen activation peptide [TAN) are evaluated and compared. The authors conclude that the most useful test includes an APACHE 11 score greater than 7 and IL-6 at the time of admission, as well as urine TAP, urine trypsinogen-2, and serum PMN-elastase at 24 hours. There are limits, however, to these approaches in part because of variations in patient responses to similar injuries. Thus, new approaches will be needed, which may include consideration of genetic factors, to improve prognostic systems and to direct effective interventions in the future.