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Overview :
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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