Editing Pancreatitis (section)

==Prognosis==
Severe acute pancreatitis has [[mortality rate]]s around 2–9%, higher where [[necrosis]] of the pancreas has occurred.<ref>{{cite journal | vauthors = Munoz A, Katerndahl DA | title = Diagnosis and management of acute pancreatitis | journal = American Family Physician | volume = 62 | issue = 1 | pages = 164–174 | date = July 2000 | pmid = 10905786 | url = http://www.aafp.org/afp/2000/0701/p164.html | url-status = live | archive-url = https://web.archive.org/web/20121008115632/http://www.aafp.org/afp/2000/0701/p164.html | archive-date = 2012-10-08 }}</ref>

Several scoring systems are used to predict the severity of an attack of pancreatitis. They each combine demographic and laboratory data to estimate severity or probability of death. Examples include [[APACHE&nbsp;II]], [[Ranson criteria|Ranson]], BISAP, and Glasgow. The Modified Glasgow criteria suggests that a case be considered severe if at least three of the following are true:<ref name="pmid2863441">{{cite journal | vauthors = Corfield AP, Cooper MJ, Williamson RC, Mayer AD, McMahon MJ, Dickson AP, Shearer MG, Imrie CW | title = Prediction of severity in acute pancreatitis: prospective comparison of three prognostic indices | journal = Lancet | volume = 2 | issue = 8452 | pages = 403–407 | date = August 1985 | pmid = 2863441 | doi = 10.1016/S0140-6736(85)92733-3 | s2cid = 46327341 }}</ref>
* Age > 55 years
* Blood levels:
** PO2 [[hypoxemia|oxygen]] < 60 mmHg or 7.9 kPa
** [[leukocytosis|White blood cells]] > 15,000/μL
** [[hypocalcemia|Calcium]] < 2&nbsp;mmol/L
** [[Blood urea nitrogen]]  > 16&nbsp;mmol/L
** [[Lactate dehydrogenase]] (LDH) > 600iu/L
** [[Aspartate transaminase]] (AST) > 200iu/L
** [[hypoalbuminemia|Albumin]] < 3.2g/L
** [[hyperglycemia|Glucose]] > 10&nbsp;mmol/L

This can be remembered using the mnemonic PANCREAS:
* PO2 [[hypoxemia|oxygen]] < 60 mmHg or 7.9 kPa
* Age > 55
* Neutrophilia [[leukocytosis|white blood cells]] > 15,000/μL
* [[hypocalcemia|Calcium]] < 2&nbsp;mmol/L
* Renal function ([[Blood urea nitrogen|BUN]]) > 16&nbsp;mmol/L
* Enzymes [[lactate dehydrogenase]] (LDH) > 600iu/L [[aspartate transaminase]] (AST) > 200iu/L
* [[hypoalbuminemia|Albumin]] < 3.2g/L
* Sugar [[hyperglycemia|glucose]] > 10&nbsp;mmol/L

The BISAP score ('''b'''lood urea nitrogen level >25&nbsp;mg/dL (8.9&nbsp;mmol/L), '''i'''mpaired mental status, [[Systemic inflammatory response syndrome|'''s'''ystemic inflammatory response syndrome]], '''a'''ge over 60 years, '''p'''leural effusion) has been validated as similar to other prognostic scoring systems.<ref name="pmid19861954">{{cite journal | vauthors = Papachristou GI, Muddana V, Yadav D, O'Connell M, Sanders MK, Slivka A, Whitcomb DC | title = Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis | journal = The American Journal of Gastroenterology | volume = 105 | issue = 2 | pages = 435–41; quiz 442 | date = February 2010 | pmid = 19861954 | doi = 10.1038/ajg.2009.622 | s2cid = 41655611 }}</ref>