Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 535

Recognizing the disease severity of acute pancreatitis has important implications for both management and prognosis. Based on the revised Atlanta criteria, pancreatitis can be classified into mild, moderately severe, and severe disease. These categories are based on objective parameters of organ failure and local complications, e.g. peripancreatic fluid collections, pseudocyst, and necrosis. In the absence of organ failure and/or local complications, pancreatitis is considered mild. Moderately severe pancreatitis presents with transient organ failure (<48 hours) and/or the presence of local complications. Finally, severe pancreatitis is characterized by persistent organ failure beyond 48 hours. As expected, organ failure is one of the strongest predictors of prolonged hospitalization and mortality.⁶ Additionally, individual lab parameters, such as elevated hematocrit and blood urea nitrogen (BUN), can also help predict outcomes. Advanced age also carries a poor prognosis. Several scoring systems have been developed to predict disease severity and clinical outcomes, including the Ranson and Glasgow scores.^7,8 Such prognostic indices are of proven value in predicting severe disease but suffer from the disadvantage that data collection is complex and must occur over 48 hours. In 2008, a simplified bedside clinical scoring system, the Bedside Index for Severity in Acute Pancreatitis (BISAP) score, was introduced. It was intended to simplify the prognostication of disease severity and predicting mortality by assessing only five variables: BUN, impairment of mental status, systemic inflammatory response (SIRS), age, and presence of pleural effusion. In a validation study, its performance was comparable to previous scoring systems.⁹ Patients with a BISAP Score >0 had an increased risk of mortality. A score of 5 predicts a mortality rate of 22%. A radiologic assessment of disease activity using CT scanning (Balthazar score) has also been studied and showed a good correlation with local complications and mortality.¹⁰