Early severity indexes in acute pancreatitis

Severe acute pancreatitis was defined at the Atlanta symposium (1) as an attack in which a complication occurs, and so severity cannot be determined until the patient has been discharged from hospital and the pre- sence or absence of complications has been documen- ted. However a prediction of severity may be made at the start of the hospital admission, based on a variety of cli- nical biochemical and radiological features. Early prediction of severity for individual patients with acute pancreatitis is important for three reasons. First, it is helpful to identify as soon as possible those patients who are most severely ill, who will require aggressive management in the intensive care unit or high dependency area. Second, specific therapy targeted to those patients with severe disease, or predicted severe disease, is becoming a clinical reality. Such therapy should not be offered to patients with mild pancreatitis, who will recover without complications, and who may suffer complications of the treatment offered. There is good evidence to support the use of endoscopic sphincterotomy in patients with gallstones and predicted severe pancreatitis and growing evidence for the use of enteral nutrition in patients with severe disease of any cause (2-8). Selection of these patients for treatment depends on early identification of those at risk of complications. Third, it is helpful when reporting studies of patients with pancreatitis to characterise the group of patients by indicating the numbers who meet criteria of predicted severity at the outset.