Search

Acute pancreatitis is one of the high-mortality gastrointestinal disorders that requires hospitalization, in this pathology there are various degrees of severity, and it is important to define and stratify them to identify dangerous patients who require aggressive treatment on admission, to identify patients worthy of referral for specialized care and to assign these patients to stratification into subgroups with persistent organ failure and local or systemic complications, the use of scales and criteria is implemented to determine the degree of severity of this and the possible management, among them we find the Ranson criteria, which contribute to the determination of severity, conduct to follow and possible complications, which is usually very useful for the patient's prognosis, but although it is true, the Ranson criteria are simple, easy to remember and very available in any laboratory to carry out ar tests, but they are also limited since they present greater specificity after the first 48 hours of the patient's admission and, in addition, they can be inconclusive because they vary according to the presence or not of a biliary pathology, thus increasing the parameters to be evaluated.

Objetivo: actualmente, en Colombia están en uso diferentes escalas para estimar el riesgo de morbimortalidad en pacientes con pancreatitis, lo que genera incertidumbre a la hora de clasificar y manejar a estos pacientes. El objetivo de este estudio es analizar la concordancia entre las más usadas en una población atendida a 2670 metros sobre el nivel del mar (msnm). Materiales y métodos: se evaluaron 200 pacientes, entre 18 y 65 años, con diagnóstico de pancreatitis aguda y manejados en el Hospital Universitario San Ignacio de Bogotá (Colombia). Se estimaron tres escalas de riesgo y se clasificaron como pancreatitis con predicción de gravedad si los puntajes de APACHE II eran ≥8, Marshall modificada ≥2, o si tenían 3 o más criterios de Ranson positivos. Se determinó la concordancia entre los resultados usando el estadístico kappa. Resultados: según Marshall, el 45,5 % de los pacientes correspondieron a pancreatitis con predicción de gravedad, mientras que de acuerdo con APACHE II y Ranson se encontró este diagnóstico en un 39,5 % y un 38,5 %, respectivamente. El coeficiente kappa mostró una concordancia débil entre APACHE II y Ranson (kappa: 0,201; intervalo de confianza [IC], 95 %: 0,05-0,34), así como una concordancia pobre entre Ranson y Marshall (kappa: 0,18; IC, 95 %: 0,04-0,32). La concordancia entre APACHE y Marshall fue moderada (kappa: 0,42; IC, 95 %: 0,28-0,56). Conclusiones: existe un pobre acuerdo entre las diferentes escalas de clasificación de riesgo de pancreatitis usadas en Colombia, por lo que no pueden interpretarse como clínicamente equivalentes. Los datos de este estudio demuestran la necesidad de validar las distintas escalas en Colombia y en Latinoamérica. Además, sugieren que la escala de Marshall sobreestima el riesgo en ciudades por encima de los 2000 msnm.

To determine changes in thiol/disulfide levels in patients with acute biliary pancreatitis for the first time, and to adapt these data to the clinic during the follow-up period. Evaluation was made of 39 acute biliary pancreatitis patients and 39 healthy control subjects. Amylase, lipase, and thiol/disulfide balance were determined from blood sampling. Prognostic markers were calculated from blood taken in the 48th hour of hospitalization of the patients. The Ranson criteria, APACHE scale, Imrei scale, C reactive protein, and procalcitonin values were calculated as prognostic markers. These were compared simultaneously with thiol/disulfide levels. Amylase and lipase levels were found to be significantly different in the experimental group compared with the control group, but there was no significant difference in the plasma thiol/disulfide balance. A minimally significant relationship was determined between C reactive protein and thiol/disulfide levels in terms of prognostic significance. The study results showed that the plasma thiol/disulfide level did not reveal the severity of acute pancreatitis. There is a need for more comprehensive studies to investigate in more detail the plasma thiol/disulfide balance which demonstrates oxidative stability.

Amaç: Acil serviste akut pankreatit (AP) tanısı alan hastaların demografik verilerinin ve etiyolojideki etkenlerin araştırılması, laboratuvar bulgularının sonlanımla ilişkisinin belirlenmesidir.Gereç ve yöntem: 2013-2017 yılları arasındaki 5 yıl süre boyunca Süleyman Demirel Üniversitesi Erişkin Acil Servisi’nde akut pankreatit tanısı alan hastaların verileri retrospektif olarak incelenmiştir. Hastaların yaş, cinsiyet, başvuru tarihi, tıbbi özgeçmişleri, şikayet ve bulguları, tetkik sonuçları, sonlanımları çalışma formuna not edilmiştir. Hasta sonlanımları hastaneye yatış ve hastane içi mortalite açısından incelenmiştir.Bulgular: Çalışmadaki toplam 603 hastanın 290’ı kadın (%48,1), 313’ü erkek (%51,9)’tir. Hastaların yaş ortalamaları 59,49±18,73 yıldır. Hastaların hastaneye başvurdukları mevsimler karşılaştırıldığında kış mevsiminde 161 (%26,7) ile en fazla, 143 (%23,7) ile ilkbahar mevsiminde en az olarak hastaneye başvurdukları görülmüştür. Başlıca pankreatit nedeni bilier pankreatittir. Taburcu olan hastaların nötrofil sayısı servis ve yoğun bakıma yatan hastalardan daha düşük, nötrofil/lenfosit oranı (NLR) yoğun bakıma yatan veya ölen hastalarda belirgin olarak yüksek, glukoz ve laktat dehidrogenaz değerleri yoğun bakıma yatırılan hastalarda daha yüksek olarak saptanmıştır. Hastane-içi mortalite %6,5 oranında saptanmıştır. Sonuç: Çalışmamızda bilier pankreatit başlıca pankreatit nedenidir. AP’te mortalite %6,5 oranındadır. Başvuru NLR değeri yoğun bakım ihtiyacı olan hastalarda ve hastane-içi mortalite ile sonuçlanan olgularda anlamlı olarak yüksek seyretmektedir., Purpose: The aim of this study is to investigate the demographic data of the patients diagnosed with acute pancreatitis (AP), find out etiological factors and relation of labortaory data with the outcome in the emergency department. Materials and methods: The data of patients diagnosed with AP in the Emergency Department of Suleyman Demirel University, between 2013 and 2017 were analyzed retrospectively. The patients' demographic, laboratory and imaging findings were noted. Patients’ outcomes were evaluated in terms of hospitalization and in-hospital mortality.Results: Of the 603 patients in the study, 290 (48.1%) were female and 313 (51.9%) were male. The mean age of the patients was 59.49±18.73 years. The most applications were in the winter (n=161 [26.7%]) and the least in the spring (n=143 [23.7%]). The neutrophil counts of the discharged patients were lower than the patients hospitalized in the ward and intensive care unit. Primary etiology of the pancreatitis was biliary. The neutrophil/lymphocyte ratio (NLR) was significantly higher in the patients hospitalized or died in the intensive care unit, and the glucose and lactate dehydrogenase values are higher in the patients hospitalized in the intensive care unit. In-hospital mortality was 6.5%.Conclusion: Biliary pancreatitis is the main cause of pancreatitis. Mortality in AP is 6.5%. The admission NLR value is increased significantly in patients who need intensive care and in cases with in-hospital mortality.

A 41-year-old woman presents to the emergency department complaining of severe and continuous epigastric pain for the past 24 hours. The pain radiates straight through to her back. She has had progressive nausea with vomiting. The vomit is bile-stained and without blood. She has had similar but less severe episodes of abdominal pain in the past, usually after eating heavy meals, but they always resolved within a few hours. She is gravida two and para two, with last menses 2 weeks ago, and does not consume any alcohol. On exam, she is afebrile, heart rate is 115 beats/min, blood pressure of 128/86 mmHg, and respiratory rate is 18/min. Her abdomen is not distended. She has no surgical scars on her abdomen and no obvious masses visible. She has no bruising around her umbilicus or along her flank. Bowel sounds are hypoactive. She has marked tenderness to palpation in her epigastrium, without guarding or rebound. The remainder of her abdomen is soft and non-tender to palpation. No masses or organomegaly are appreciated. Laboratory examination reveals a white blood cell count of 17.2 × 103cells/μL (normal 4.1–10.9 × 103 cells/uL), amylase of 1545 u/L (30–110 u/L), lipase of 1134 u/L (7–60 u/L), ALT of 245 u/L (7–56 u/L), AST of 263 u/L (5–35 u/L), serum glucose of 156 mg/dl (65–110 mg/dL), and LDH 180 u/L (0–250 u/L). An abdominal series demonstrates gas throughout the small and large bowel and a focal dilated loop of proximal small bowel without air fluid levels. There is no free air under the diaphragm.

Background Literature has suggested that imaging is over-utilized in the diagnosis of pancreatitis. If the diagnosis of acute pancreatitis (AP) is established with abdominal pain and increased serum amylase or lipase activity without systemic signs of severe disease, computed tomography (CT) imaging may not be necessary. We hypothesize that among patients with uncomplicated acute pancreatitis (AUP), there is a significant number of unwarranted CT imaging studies. This imposes increased expenditure and cost in our healthcare system and does not improve hospital stay or management of AUP. Aim To assess the overutilization and associated cost of CT imaging among patients meeting diagnostic criteria for AUP. Methods In this Institutional Review Board-approved retrospective, single-center study, we identified all adult patients admitted with AP from January 1, 2012 through October 1, 2017. Patients were identified via International Classification of Diseases (ICD-9) code for AP (577.0) and ICD-10 codes for different etiological AP (K85.9 unspecified, K85.0 idiopathic, K85.1 biliary, K85.2 alcohol-induced, K85.3 drug-induced, and K85.8 other). Diagnosis was confirmed by chart review using established non-imaging diagnostic criteria (presence of typical abdominal pain and elevated lipase or amylase greater than 3 times upper limit of normal). Ranson criteria and BISAP scores on presentation were calculated and patients that met scores less than or equal to 2 for both were included to suggest AUP. The utilization and cost of imaging in these patients were recorded. Results Between January 2012 and October 2017, 1305 patients presented to the emergency department with AP, and 405 patients (31%) met our inclusion criteria for AUP (201 males, 204 females; mean age 49 years, range 18-98). Of those, 210 patients (51.85%) underwent CT imaging. One patient (0.47%) had evidence of pancreatic necrosis, one patient had cyst formation (0.47%), and the remaining 208 patients (99.05%) had either normal CT scan imaging or findings consistent with mild AP without necrosis. The average cost of CT scan imaging was $4510 with a total cost of $947056. Median length of hospitalization stay was 3 d among both groups. Combining Ranson's Criteria and BISAP score identified AUP in our patient population with an accuracy of 99.5%. Conclusion CT imaging is unnecessary when AUP is diagnosed clinically and biochemically. Reducing overuse of diagnostic CT scans will decrease healthcare expenditure and radiation exposure to patients.

Background Acute pancreatitis is a frequent reason for patient presentation to the emergency department (ED) and the most common gastrointestinal disease resulting in admission. Emergency clinicians are often responsible for the diagnosis and initial management of acute pancreatitis. Objective This review article provides emergency clinicians with a focused overview of the diagnosis and management of pancreatitis. Discussion Pancreatitis is an inflammatory process within the pancreas. While the disease is often mild, severe forms can have a mortality rate of up to 30%. The diagnosis of pancreatitis requires two of the following three criteria: epigastric abdominal pain, an elevated lipase, and imaging findings of pancreatic inflammation. The most common etiologies include gallbladder disease and alcohol use. After the diagnosis has been made, it is important to identify underlying etiologies requiring specific intervention, as well as obtain a right upper quadrant ultrasound. The initial management of choice is fluid resuscitation and pain control. Recent data have suggested that more cautious fluid resuscitation in the first 24 h might be more appropriate for some patients. Intravenous opiates are generally safe if used judiciously. Appropriate disposition is a multifactorial decision, which can be facilitated by using Ranson criteria or the Bedside Index of Severity in Acute Pancreatitis score. Complications, though rare, can be severe. Conclusions Pancreatitis is a potentially deadly disease that commonly presents to most emergency departments. It is important for clinicians to be aware of the current evidence regarding the diagnosis, treatment, and disposition of these patients.

To assess the effectiveness of a new scale known as “Emergency department SpO2 (peripheral capillary oxygen saturation), age, and SIRS (Systemic inflammatory response syndrome)” (ED-SAS) that can be used to predict prognosis within 24 hours following presentation compatible with acute pancreatitis in patients admitted to the emergency department. This research project was conducted as a single-center, retrospective, cohort study. The Acute Physiology and Chronic Health Evaluation II (APACHE II), SIRS, Bedside Index for Severity in Acute Pancreatitis (BISAP), ED-SAS, modified Glasgow Scale and Ranson criteria scoring of the patients were evaluated using their presentation data screened from the hospital automation system. Then, the efficiencies of these evaluation systems were compared using the receiving operating curve (ROC). The conformity of the data to the normal distribution was checked with the Kolmogorov-Smirnov test. The ROC analyses were employed to identify the cut-off values of the scoring systems in calculating death rates. The method developed by DeLong et al. was used to compare the ROC curves of the scoring systems. The study has been completed with 235 patients, 91 (38.7%) male and 144 (61.3%) female, with a mean age of 63.1 ± 17.7 years. In the ROC analysis of the ED-SAS evaluation tool to predict death rates, the area under the curve (AUC) value was found to be 0.85 (95% confidence interval: 0.79–0.89), and the Youden index was 0.62, with a p value of 0.001. Mortality prediction with ED-SAS significantly differed compared to the Ranson and SIRS scoring systems (P = 0.001 and P = 0.03, respectively). However, no statistically significant difference was found in the comparison of the ED-SAS score with the modified Glasgow and APACHE II scores (P = 0.12 and P = 0.54, respectively). It was concluded that the Baseband ED-SAS scores provided equally significant results in terms of AUC at the 95% confidence interval (P = 0.05). Statistical analyses revealed that the APACHE II, SIRS, BISAP, modified Glasgow and ED-SAS scores were found to be significantly higher among the dead in comparison to the survivors (P < 0.05). ED-SAS constitutes a simple, fast, expedient and effective evaluation system that can be utilized to predict mortality in acute pancreatitis in the emergency setting.

Acute pancreatitis (AP) represents a common potentially life-threatening disease mostly related to gallstone or alcohol abuse with an overall mortality rate of around 5%. Despite the reported incidence burden on 30 to 40-year-old persons, a higher peak is also reported in persons older than 65 years who usually fall an easy prey to this disease due to compromised body systems. For an adequate management, a central role is represented by a mix of prompt diagnosis, by a precise radiological/computed tomography (CT) scan-mediated classification (Atlanta Classification and Determinant-based classification), and by the clinical severity scores (e.g., Ranson criteria, Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score (SAPS II), Bedside Index of Severity in Acute Pancreatitis (BISAP), etc.). This chapter explores the impact of age and personal fragility (comorbidities and chronically ill) on disease severity and subsequent medical/surgical options.

BACKGROUND: Pancreatitis is an inflammation of the pancreatic tissue. Gallstones are known to be the most common cause of acute pancreatitis, especially in eastern countries, including Iran. Pancreatitis, in its course, can cause complications for the patient. Different systems have been identified as predictors of the severity of acute pancreatitis. As a result, we decided to examine the factors influencing the severity of biliary pancreatitis and their relationship with the complications in Iranian society. METHODS: The present study is a cross-sectional, analytical study that was performed retrospectively on 160 patients with biliary pancreatitis. The main and dependent variable in this study is the severity of pancreatitis, which is divided into two groups of complications (local complications and systemic complications) and without complications. The necessary information was extracted from the patients' files and evaluated with SPSS software version 22. RESULTS: Based on the results of single-variable analysis, there was a significant relationship between the patient’s age, sex, Ranson and CRP criteria, and complication of the disease. In the univariate analysis, no significant statistical relationship was found between patients' BMI(Body Mass Index), CBD (common bile duct) size, serum alkaline phosphatase level, gallstone size, and FBS(Fasting blood sugar), and the complications of the disease, based on the multivariate analysis results. CONCLUSION: The results of this study showed that four variables of the female sex, stone size, CRP, and high score of Ranson criteria act as independent risk factors in the development of complicating biliary pancreatitis.

ResumenLa pancreatitis aguda es un proceso inflamatorio del páncreas con elevada mortalidad. La medición de la presión intra-abdominal es útil para el pronóstico del paciente como predictor de falla orgánica y mortalidad. El objetivo del trabajo fue determinar la importancia de la presión intra-abdominal y la relación con la severidad de pancreatitis en un hospital público de Tabasco, México.Método: Se realizó un estudio con diseño analítico, longitudinal, se estudió una muestra de 32 pacientes con diagnóstico de pancreatitis aguda a través de muestreo por conveniencia. Las variables de estudio fueron edad, sexo, criterios de RANSON, APACHE II, Presión intra-abdominal, y parámetros bioquímicos, se obtuvieron medidas de tendencia central y la prueba de T de Student.Resultados: La media de edad fue de 47.34±17.7 años, el 56.3% (n=18) fueron hombres, el 15.6% (n=5) tuvieron resultados ≥3 puntos de acuerdo a los criterios de Ranson, la media de la Presión intraabdominal inicial de 9.1 ±1.5 mmHg y a las 24 horas 10.3±2.5 mmHg relacionado con la severidad de forma estadísticamente significativa. Conclusiones: La medición de la presión intra-abdominal es una herramienta útil para dar tratamiento oportuno y valorar el pronóstico del paciente. Palabras clave: Pancreatitis; severidad; pronóstico. AbstractAcute pancreatitis is an inflammatory process of the pancreas with high mortality. The measurement of intra-abdominal pressure is useful for the prognosis of the patient as a predictor of organ failure and mortality. The objective of the study was to determine the importance of intra-abdominal pressure and the relationship with the severity of pancreatitis in a public hospital in Tabasco, Mexico. Method: A study was carried out with an analytical, longitudinal design. A sample of 32 patients diagnosed with acute pancreatitis was studied through convenience sampling. The study variables were age, sex, criteria of RANSON, APACHE II, intra-abdominal pressure, and biochemical parameters, measures of central tendency and the Student's T test were obtained. Results: The mean age was 47.34 ± 17.7 years, 56.3% (n = 18) were men, 15.6% (n = 5) had results ≥3 points according to the Ranson criteria, the mean of the Pressure initial intraabdominal of 9.1 ± 1.5 mmHg and at 24 hours 10.3 ± 2.5 mmHg related to severity in a statistically significant way. Conclusions: The measurement of intra-abdominal pressure is a useful tool to give timely treatment and assess the patient's prognosis. Keywords: Pancreatitis; severity; forecast

The objective of our study was to develop a decision tree model for the early prediction of the severity of acute pancreatitis (AP) using clinical and radiologic scoring systems.For this retrospective study, 192 patients with AP who underwent CT 72 hours or less after symptom onset were divided into two cohorts: a training cohort (n = 115) and a validation cohort (n = 77). Univariate analysis was performed to identify significant parameters for the prediction of severe AP in the training cohort. For early prediction of disease severity, a classification tree analysis (CTA) model was constructed using significant scoring systems shown by univariate analysis. To assess the diagnostic performance of the model, we compared the area under the ROC curve (AUC) with each selected single parameter. We also evaluated the diagnostic performance in the validation cohort.The Acute Physiology and Chronic Health Evaluation (APACHE)-II score, bedside index for severity in acute pancreatitis (BISAP) score, extrapancreatic inflammation on CT (EPIC) score, and Balthazar grade were included in the CTA model. In the training cohort, our CTA model showed a trend of a higher AUC (0.853) than the AUC of each single parameter (APACHE-II score, 0.835; BISAP score, 0.842; EPIC score, 0.739; Balthazar grade, 0.700) (all, p0.0125) while achieving specificity (100%) higher than and accuracy (94.8%) comparable to each single parameter (both, p0.0125). In the validation cohort, the CTA model achieved diagnostic performance similar to the training cohort with an AUC of 0.833.Our CTA model consisted of clinical (i.e., APACHE-II and BISAP scores) and radiologic (i.e., Balthazar grade and EPIC score) scoring systems and may be useful for the early prediction of the severity of AP and identification of high-risk patients who require close surveillance.

Clinical severity of Acute Pancreatitis (AP) following the use of Aspirin is inconclusive in previous studies. This study investigated predicting the severity of AP using Ranson criteria at admission and at 48 hours and, the length of hospital stay by prior aspirin use. Medical records of first-presentation AP patients during the five years between 2010 and 2015 were examined in the Goulburn Valley Base Hospital, Victoria, Australia. Uses of aspirin at admission with some co-morbidity, Ranson criteria at admission and at 48 hours, duration of hospital stay including other information were collected. A total of 245 AP medical records were reviewed, of them, 178 used and 67 did not use aspirin prior attending to the hospital. In simple regression analysis, Ranson score was 60% higher at admission (P< 0.001) and 64% higher at 48 hours (P

Purpose The aim of this study was to compare the prognostic value of established scoring systems with early warning scores in a large cohort of patients with acute pancreatitis. Methods In patients presenting with acute pancreatitis, age, sex, American Society of Anaesthesiologists (ASA) grade, Modified Glasgow Score, Ranson criteria, APACHE II scores and early warning score (EWS) were recorded for the first 72 h following admission. These variables were compared between survivors and non-survivors, between patients with mild/moderate and severe pancreatitis (based on the 2012 Atlanta Classification) and between patients with a favourable or adverse outcome. Results A total of 629 patients were identified. EWS was the best predictor of adverse outcome amongst all of the assessed variables (area under curve (AUC) values 0.81, 0.84 and 0.83 for days 1, 2 and 3, respectively) and was the most accurate predictor of mortality on both days 2 and 3 (AUC values of 0.88 and 0.89, respectively). Multivariable analysis revealed that an EWS ≥2 was independently associated with severity of pancreatitis, adverse outcome and mortality. Conclusion This study confirms the usefulness of EWS in predicting the outcome of acute pancreatitis. It should become the mainstay of risk stratification in patients with acute pancreatitis.

Background: The management of the moderate and severe forms of acute pancreatitis (AP) with necrosis and multiorgan failure remains a challenge. To predict the severity and mortality of AP multiple clinical, laboratory-, and imaging-based scoring systems are available. Aim: To investigate, if the computed tomography severity index (CTSI) can predict the outcomes of AP better than other scoring systems. Methods: A systematic search was performed in three databases: Pubmed, Embase, and the Cochrane Library. Eligible records provided data from consecutive AP cases and used CTSI or modified CTSI (mCTSI) alone or in combination with other prognostic scores [Ranson, bedside index of severity in acute pancreatitis (BISAP), Acute Physiology, and Chronic Health Examination II (APACHE II), C-reactive protein (CRP)] for the evaluation of severity or mortality of AP. Area under the curves (AUCs) with 95% confidence intervals (CIs) were calculated and aggregated with STATA 14 software using the metandi module. Results: Altogether, 30 studies were included in our meta-analysis, which contained the data of 5,988 AP cases. The pooled AUC for the prediction of mortality was 0.79 (CI 0.73-0.86) for CTSI; 0.87 (CI 0.83-0.90) for BISAP; 0.80 (CI 0.72-0.89) for mCTSI; 0.73 (CI 0.66-0.81) for CRP level; 0.87 (CI 0.81-0.92) for the Ranson score; and 0.91 (CI 0.88-0.93) for the APACHE II score. The APACHE II scoring system had significantly higher predictive value for mortality than CTSI and CRP (p = 0.001 and p < 0.001, respectively), while the predictive value of CTSI was not statistically different from that of BISAP, mCTSI, CRP, or Ranson criteria. The AUC for the prediction of severity of AP were 0.80 (CI 0.76-0.85) for CTSI; 0.79, (CI 0.72-0.86) for BISAP; 0.83 (CI 0.75-0.91) for mCTSI; 0.73 (CI 0.64-0.83) for CRP level; 0.81 (CI 0.75-0.87) for Ranson score and 0.80 (CI 0.77-0.83) for APACHE II score. Regarding severity, all tools performed equally. Conclusion: Though APACHE II is the most accurate predictor of mortality, CTSI is a good predictor of both mortality and AP severity. When the CT scan has been performed, CTSI is an easily calculable and informative tool, which should be used more often in routine clinical practice.

Severity stratification and prognostic prediction at early stage is crucial for reducing the rates of mortality of patients with acute pancreatitis (AP). We aim to investigate the predicting performance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red-cell distribution width (RDW) combined with severity scores (sequential organ failure assessment [SOFA], bed-side index for severity of AP [BISAP], Ranson criteria, and acute physiology and chronic health evaluation II [APACHE II]) for severe AP (SAP) and mortality. A total of 406 patients diagnosed with AP admitted in a tertiary teaching hospital were enrolled. Demographic information and clinical parameters were retrospectively collected and analyzed. NLR, PLR, RDW, blood urea nitrogen (BUN), and AP severity scores (SOFA, BISAP, Ranson, and APACHE II) were compared between different severity groups and the survival and death group. Receiver-operating characteristic (ROC) curves for SAP and 28-day mortality were calculated for each predictor using cut-off values. Area under the curve (AUC) analysis and logistic regression models were performed to compare the performance of laboratory biomarkers and severity scores. Our results showed that NLR, PLR, RDW, glucose, and BUN level of the SAP group were significantly increased compared to the mild acute pancreatitis (MAP) group on admission (P

Amaç: Bu çalışmada sistemik inflamasyon ile ilişkili bir marker olduğu gösterilen; Nötrofillenfosit oranı (NLR), platelet-lenfosit oranı (PLR), ortalama trombosit hacmi (MPV) ve Eritrosit dağılım hacmi (RDW) ile akut pankreatitin (AP) başvuru anındaki ciddiyetini gösteren Ranson kriteri ile aralarındaki ilişkinin gösterilmesi amaçlanmıştır.Gereç ve Yöntem: Ocak 2017 ile Kasım 2018 tarihleri arasında AP tanısı ile takip eden hastaların verilerine retrospektif olarak ulaşıldı. 82 biliyer ve 15 nonbiliyer olmak üzere toplam 139 hasta çalışmaya alındı. Hastaların ilk başvuru anında bakılan hemogram ve biyokimyasal parametreleri, yaşları, cinsiyetleri, ko-morbiditeleri ve yatış süreleri kaydedildi. İlk başvuru anında bakılan Ranson Kriterlerine göre skoru < 3 ve skoru ≥ 3 pozitif olanlar olmak üzere 2 gruba ayrıldı ve bu gruplar karşılaştırıldı.Bulgular: AP tanısı ile takip edilen 139 hastanın 75 (%54)’i erkek, 64 (%46)’ü kadındı. Hastaların 113’ü Ranson kriterlerine göre 3’ün altında 26’sı ise 3 ve üzerindeydi. Ortalama yaş hafif AP grubunda 61±20 yıl, şiddetli AP grubunda ise 70±13 yıldı. MPV (P< 0.001) ve NLR (P< 0.001) değerleri gruplar arasında anlamlı olarak farklı saptandı. Korelasyon analizinde; NLR ile ranson skoru arasında pozitif korelasyon saptandı (r= 0,253 p, Objective: In this study we have shown that there is a marker associated with systemic inflammation; The aim of this study was to determine the relationship between neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), mean platelet volume (MPV) and Erythrocyte distribution volume (RDW) and Ranson Criteria showing the severity of acute pancreatitis (AP) at the time of presentation.Methods: The data of the patients who were diagnosed with AP between January 2017 and November 2018 were retrospectively obtained. A total of 139 patients (82 biliary and 15 nonbiliary) were included in the study. Hemogram and biochemical parameters, age, gender, co-morbidities and duration of hospitalization were recorded. According to the Ranson Criteria used at the time of admission score < 3 and score ≥ 3 positive and these groups were compared.Results: Of the 139 patients diagnosed with AP, 75 (54%) were male and 64 (46%) were female. 113 of the patients were divided into two groups according to the Ranson criteria. The mean age was 61 ±20 years in the mild AP group and 70 ±13 years in the severe AP group. MPV (P

Background Pediatric acute pancreatitis (AP) is a rare but important clinical entity associated with significant morbidity. Predicting the severity and outcome of AP in pediatric patients can be challenging because there are few validated severity scoring systems. Moreover, the etiology of pediatric AP in the Japanese population is different from that of Western populations. The performance of severity scores in pediatric AP with a high prevalence of severe cases is still unknown. The aim of this study was to assess the performance of existing severity scoring systems when used for Japanese children at a tertiary care center. Methods We reviewed the electronic medical records of all children (≤18 years) treated for AP at between 2002 and 2012 at National Center for Child Health and Development, Tokyo. The modified Glasgow acute pancreatitis severity score (modified Glasgow), Ranson criteria (Ranson), Balthazar computed tomography severity index (CTSI), and pediatric acute pancreatitis severity (PAPS) score were assessed for their ability to distinguish severe pancreatitis from the milder forms. Results Thirty-three Japanese children with AP were identified. Among them, 37 episodes were analyzed for the performance of the scoring systems and 33 for the etiology. The most common etiology of AP was structural abnormality (n = 8). Sensitivity for the modified Glasgow, Ranson, PAPS, and CTSI was 42.9%, 52.4%, 81.0%, and 50.0%, respectively, while specificity was 81.3%, 81.3%, 37.5%, and 76.9%, respectively. Conclusion We found PAPS to be the most reliable when used for discriminating the severe form of AP from the milder forms at a Japanese tertiary pediatric care center.

Aim: To determine the relationship of red cell distribution width (RDW) and C-reactive protein (CRP)/albumin ratio with Ranson criteria, 2012 revised Atlanta Scoring and Balthazar Scoring in patients with acute pancreatitis (AP), which are used in daily practice to estimate the AP severity.Material and Methods: RDW was documented from the complete blood count at the time of patient admission to the hospital. On the second day of hospitalization, the CRP/albumin ratio was calculated as the ratio of absolute CRP to albumin. The relationship between the patients’ RDW levels and CRP/albumin ratio, with the length of hospital stay, and Ranson, Revised Atlanta criteria and Balthazar scores were investigated.Results: In a total of 152 patients with a mean age of 51.58 ± 15.58 years (range: 19-76) were included in the study. Among participants 82 (53.9%) were female and 70 (46.1%) were male. Among study participants, according to Ranson criteria, 117 were having mild and 35 were having severe AP; regarding Atlanta classification, 116 were having mild and 36 were having severe AP and according to the Baltahazar classification 122 were having mild-moderate and 30 were having severe AP. The mean hospitalization period was 7.14 ±4.17 days (range: 2-27 days). RDW and CRP/albumin ratio are compared between mild-moderate and severe AP groups defined with Ranson, Atlanta and Baltahazar classifications. There was not any significant difference between groups regarding RDW values; however, CRP/albumin ratio was significantly different between groups defined with all three classifications (p: 0.001). There was not any correlation between RDW and any of the scores or hospitalization period; however, CRP/albumin ratio showed significant moderate correlation with all of the scores and hospitalization period.Conclusion: We suggest that, CRP/albumin ratio is a good prognostic marker in predicting severe AP; however RDW values did not have any predictive value regarding the severity of AP.

BACKGROUND Acute pancreatitis (AP) is one of the major pathologies among gastrointestinal system diseases. The aim of this study was to determine the relationship between the red cell distribution width (RDW) value and the C-reactive protein (CRP)/ albumin ratio in patients with AP. METHODS In this retrospective study, AP cases were enrolled and divided into 2 groups according to the Ranson criteria as moderate or severe pancreatitis. The RDW and CRP/albumin values, length of hospitalization and stay in the intensive care unit (ICU), and the complications experienced were compared between these 2 groups. RESULTS A total of 264 patients were included in the study. Moderate pancreatitis was detected in 204 patients (77.2%) while severe pancreatitis was seen in 60 patients (22.8%) (p=0.081). There was no statistically significant difference in the RDW value between the groups (p=0.193). The CRP/albumin values were significantly higher in the severe pancreatitis group compared with the moderate group (p

Hypertriglyceridemia is the third most common worldwide cause of acute pancreatitis. Resolving the underlying etiology is imperative for optimal management. This is especially true with regard to hypertriglyceridemia, as this etiology may cause more severe acute pancreatitis and worse symptoms than other causes of the disease. Many pharmacological treatment options for hypertriglyceridemia-induced acute pancreatitis (HTGP) have been proposed; however, the safety and efficacy for specific treatment regimens remain nebulous. At our institution, 6 patients, whose average Ranson criteria score were 5 and presenting triglyceride concentrations were 3501 mg/dL, were managed with a continuous infusion of insulin, subcutaneous heparin, and oral gemfibrozil for HTGP. Maximum insulin infusion rates ranged from 0.8 to 20.9 U/h. Half of the patients received nongemfibrozil cholesterol medication. Five patients experienced a resolution of HTGP (median day 3). The only adverse drug event was hypoglycemia in a single patient. Combination therapy with heparin, insulin, and gemfibrozil is safe and efficacious in quickly lowering serum triglyceride concentrations in HTGP. This combination warrants further study.

Introduction Severe acute pancreatitis has a high mortality and its early identification is important for management and risk stratification. The bedside index for severity in acute pancreatitis (BISAP) is a simple scoring system done at admission which predicts the severity of pancreatitis. Procalcitonin is an inflammatory marker which is raised very early and helps in early prediction of the severity of disease. This study aims to evaluate the BISAP score and Procalcitonin in prognostication of acute pancreatitis. Methods A prospective observational study of 60 patients presenting with acute pancreatitis was done at XXX Medical College and Hospital from July 2015 to June 2016. BISAP, APACHE-II, Ranson criteria, and CT severity index (CTSI) of all patients were calculated. Procalcitonin card test was done for all patients. The patients were stratified according by BISAP score and procalcitonin positivity into categories of severe pancreatitis, organ failure and pancreatic necrosis, as well as the number of deaths. The comparison of BISAP with other scoring systems, Procalcitonin (PCT), C-reactive protein (CRP), hematocrit, and body mass index (BMI) was done by the area under the receiver-operating curve (AUC) to prediction of severe acute pancreatitis, organ failure, necrosis, and death. Results Of the 60 patients, 14 (23.3%) developed severe acute pancreatitis, 11 (18.3%) Organ failure, 21 (35%) pancreatic necrosis and 7 (11.6%) died. A BISAP score of ≥3 was a statistically significant cutoff value. AUCs for predicting severe pancreatitis and death of BISAP were 0.875 and 0.740respectively, similar to those for Ranson criteria (0.802, 0.763) and APACHE-II (0.891, 0.769) and greater than AUCs for CTSI (0.641, 0.554). The AUC for prediction of organ failure were 0.906, 0.833, 0.874 and 0.623 for BISAP, Ranson criteria, APACHE-II, and CTSI respectively. AUCs for PCT predicting severity, organ failure, and death were 0.940, 0.923 and 0.769 respectively were similar to BISAP but greater than those for CRP (0.755, 0.719, 0.693), hematocrit (0.540, 0.570, 0.550), and BMI (0.493, 0.523, 0.497). Conclusion The BISAP predicts severity, organ failure and death, in acute pancreatitis very well.It is as good as APACHE-II but better than Ranson criteria, CTSI, CRP, hematocrit, and BMI. PCT is a promising inflammatory marker with prediction rates similar to BISAP.

Background Acute pancreatitis (AP) is a common presentation in the emergency department (ED). Severity of pancreatitis is an important consideration for ED clinicians making admission judgments. Validated scoring systems can be a helpful tool in this process. Objective The aim of this review is to give a general outline on the subject of AP and compare different criteria used to predict severity of disease for use in the ED. Discussion This review updates the classifications and scoring systems for AP and the relevant parameters of each. This article assesses past and current scoring systems for AP, including Ranson criteria, Glasgow criteria, Acute Physiology and Chronic Health Evaluation II (APACHE II), computed tomography imaging scoring systems, Bedside Index of Severity in Acute Pancreatitis (BISAP) score, Panc 3, Harmless Acute Pancreatitis Score (HAPS), and the Japanese Severity Score. This article also describes the potential use of single variable predictors. Finally, this article discusses risk factors for early readmission, an outcome pertinent to emergency physicians. These parameters may be used to risk-stratify patients presenting to the ED into mild, moderate, and severe pancreatitis for determination of appropriate disposition. Conclusion Rapid, reliable, and validated means of predicting patient outcome from rapid clinical assessment are of value to the emergency physician. Scoring systems such as BISAP, HAPS, and single-variable predictors may assist in decision-making due to their simplicity of use and applicability within the first 24 h.

Introduction: Acute pancreatits (AP) still reqiures better diagnostic and therapeutic options to be introduced in order to decrease its morbidity and mortality. It appears that the assessment of serum levels of interleukin 18 (IL-18) and its correlation with C-reactive protein (CRP) may provide adequate prognostic value. Aim: To measure serum concentrations of IL-18 and inflammation markers such as CRP in patients with AP during subsequent hospital stay days and to assess the role of IL-18 as an early AP marker and prognostic factor. Material and methods: Thirty-two patients aged 47 ±16.7 years were included into the study (17 males and 15 females), in whom AP was diagnosed based on ultrasound and computer aided tomography imaging and amylase. Serum amylase, CRP, and IL-18 levels were measured on the 1st, 2nd, 3rd, and 5th days of hospital stay. All patients were scored “B” according to Balthazar and mild AP based on Ranson criteria. The control group consisted of 30 healthy volunteers aged 50.7 ±12.4 years (15 males and 15 females). Results: The average IL-18 serum level in the control group was 86.91 ±4.94 pg/ml. Mean IL-18 study group levels were 128.4 ±7.6 pg/ml on the 1 st , 112.0 ±4.4 pg/ml on the 3 rd , and 122.8 ±6.8 pg/ml on the 5 th day of AP, and were significantly higher than those in the control group, accordingly: p < 0.001, p < 0.005, p < 0.001. A positive correlation between IL-18 and CRP serum concentrations was observed. A slight increase in correlation was observed as the days went by. Conclusions: We concluded that the serum IL-18 level increases in the initial phase of AP , and it may be used as an inflamma tory reaction marker in patients with AP, and it is correlated with CRP, which may indicate its prognostic role in AP.

Background In this retrospective study, we aimed to assess the reliability of early cholecystectomy, risk of recurrent biliary pancreatitis, and their effects on hospital length of stay and morbidity by comparing the results of early and late laparoscopic cholecystectomy in patients with acute biliary pancreatitis. Methods A total of 131 patients, who were diagnosed with acute biliary pancreatitis at Okmeydani Education and Research Hospital in January 2009-December 2012, were included in the study. Demographic specifications of patients, duration of their complaints, biochemistry and hemogram values at first arrival, Ranson criteria, number of attacks, screenings, operation type and period, number of days between the first attack and operation, hospital length of stay, and complications were recorded. Patients who underwent cholecystectomy within the first 2 weeks were considered early (group 1) and those who under the operation after 2 weeks were considered late (group 2). Results There were 47 patients in group 1 and 84 patients in group 2. Open surgery was not performed on any patient, and there was no choledoch injury and mortality. The average hospital length of stay was 7.6±3.0 days in group 1 and 10.7±8.3 days in group 2, with a statistically significant difference between the groups (p=0.006). Two or more number of attacks occurred in 15 patients in group 2 (18%), with a statistically significant difference between the groups (p=0.000). Conclusion Laparoscopic cholecystectomy is safe as it does not increase operation time and morbidity in biliary pancreatitis with a Ranson score of ≤3 or cause difficulty in dissection. Late cholecystectomy causes recurrent attacks and increases the hospital length of stay and treatment costs. Using randomized controlled studies, the effectiveness and reliability of early cholecystectomy in mild and moderate biliary pancreatitis can be verified.

Introduction: Acute pancreatitis (AP) is a clinical condition, which shouldbe included in the differential diagnosis of patients presenting with abdominalpain, nausea and vomiting. In this study, we aimed to investigatepatients diagnosed as AP in our clinic.Methods: Eighty four cases with AP in Sakarya Training and ResearchHospital Internal Medicine Clinic in 2009-2010 were included in the studyretrospectively. Demographic characteristics, disease severity, treatment,prognosis, length of hospital stay of cases were recorded. Then,associations between disease severity with etiological factors, age, sex,length of stay and prognosis were evaluated.Results: The etiologies of the 55 patients (66 %) had acute biliary pancreatitis.Severe pancreatitis was observed in 25 % of cases according toRanson’s criteria. The mortality rate was 5%. It was found no correlationbetween severity of disease with demographic characteristics, clinicaland laboratory findings and length of stay. Mortality was higher in thesevere pancreatitis group (p, Giriş: Akut pankreatit (AP), karın ağrısı, bulantı, kusma yakınmaları ilebaşvuran olgularda ayırıcı tanıda yer alması gereken klinik bir tablodur. Buçalışmada kliniğimizde akut pankreatit tanısı ile izlenen olguların incelenmesiamaçlandı.Metod: 2009-2010 yıllarında Sakarya Eğitim ve Araştırma Hastanesi İçHastalıkları Kliniğinde akut pankreatit tanısıyla takip edilen 84 olgu çalışmakapsamına alındı ve geriye dönük olarak analiz edildi. Olgularındemografik özellikleri, hastalık şiddeti, uygulanan tedavi, prognoz, hastanedeyatış süresi kaydedildi. Daha sonra hastalık şiddeti ile etyolojikfaktörler, yaş, cinsiyet, yatış süresi ve prognoz arasındaki ilişki incelendi.Bulgular: Etiyolojik olarak 55 olguda (% 66) akut biliyer pankreatit saptandı.Ranson kriterlerine göre 21 olguda (% 25) şiddetli pankreatit gözlendi.Mortalite oranı % 5 (4 olgu) bulundu. Hastalık şiddeti ile demografiközellikler, klinik ve laboratuar bulgular ve yatış süreleri arasında ilişki saptanmadı.Mortalite şiddetli grupta daha yüksekti (p< 0,05).Sonuç: AP etyolojisindeki en önemli faktör safra kesesi taşları olmaklabirlikte, idiyopatik ve diğer nadir nedenler göz ardı edilmemelidir Hafif yada şiddetli akut pankreatitte başlangıçta benzer klinik tablolar görülebileceğindenhastalık şiddetini belirlemede prognostik skorlama sistemlerindenyararlanılmalıdır

Background The bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactor scoring system. As there were no studies designed to validate this system according to the latest Atlanta classification in China and more data are needed before clinical application, we compared BISAP, the Acute Physiology and Chronic Health Evaluation (APACHE) II and Ranson scoring systems in predicting the severity, pancreatic necrosis and mortality of acute pancreatitis (AP) using the latest 2012 Atlanta classification in a tertiary care center in China. Methods The medical records of all patients with AP admitted to our hospitals between January 2010 and June 2013 were reviewed retrospectively. Severe AP was defined as the persistence of organ failure for more than 48 h. The capacity of the BISAP, APACHE II and Ranson's score system to predict severity, pancreatic necrosis and mortality was evaluated using linear-by-linear association. The predictive accuracy of the BISAP, APACHE II and Ranson's score was measured as the area under the receiver operating characteristic curve (AUC). Results Of 155 patients enrolled in the study, 16.7% were classified as having severe AP, and six (3.2%) died. There were statistically significant trends for increasing severity (P < 0.001), PNec (P < 0.001) and mortality (P < 0.001) with increasing BISAP. The AUC for severity predicted by BISAP was 0.793 (95% confidence interval [CI] 0.700–0.886), APACHE II 0.836 (95% CI 0.744–0.928) and by Ranson score was 0.903 (95% CI 0.814–0.992). The AUC for PNec predicted by BISAP was 0.834 (95% CI 0.739–0.929), APACHE II 0.801 (95% CI 0.691–0.910) and by Ranson score was 0.840 (95% CI 0.741–0.939). The AUC for mortality predicted by BISAP was 0.791 (95% CI 0.593–0.989), APACHE II 0.812 (95% CI 0.717–0.906) and by Ranson score was 0.904 (95% CI 0.829–0.979). Conclusions BISAP score may be a valuable source for risk stratification and prognostic prediction in Chinese patients with AP. A prospective and multicenter validation study is required to confirm our results and further our recognition of BISAP scores in AP.

Background Acute pancreatitis (AP) varies in severity, prompting development of systems aimed at predicting prognosis to help guide therapy. Although several prediction approaches are available, their test characteristics and clinical utility are not completely understood. Purpose To evaluate the test characteristics (prognostic accuracy, incremental predictive value) and clinical utility (effect on patient outcomes) of severity scores for predicting mortality in AP. Data sources Ovid MEDLINE and EMBASE (inception to 3 May 2016). Study selection Longitudinal studies, in any language, that evaluated the prognostic value of at least 1 clinical severity score in AP. Data extraction Dual data extraction and quality assessment. Data synthesis Of 4039 citations screened, 94 unique studies evaluating 18 scores in 53 547 patients met the inclusion criteria. All studies provided data on prognostic accuracy, whereas 6 provided data on incremental predictive values. Most scores demonstrated low prognostic accuracy. The Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Ranson criteria were studied most extensively. The median sensitivity and specificity of APACHE II at a threshold of 7 were 100% (range, 68% to 100%) and 63% (range, 21% to 96%), respectively, and those of the Ranson criteria at a threshold of 2 were 90% (range, 0% to 100%) and 67% (range, 14% to 97%), respectively. Estimates of sensitivity were based on relatively few patients. Evidence was limited regarding the incremental predictive value of the scoring systems or their effect on patient outcomes. Limitation Substantial clinical heterogeneity and inadequate methodological and reporting quality precluded a meta-analysis. Conclusion The test characteristics and clinical utility of AP severity scores remain uncertain. Additional studies with improved methodological rigor are needed, and the development of new scoring systems may be justified. Primary funding source Global Scholarship Programme for Research Excellence for 2014 to 2015, The Chinese University of Hong Kong.

"An otherwise healthy 37-year-old man was admitted to hospital with uncontrollable vomiting and abdominal pain. Lithiasic acute pancreatitis was diagnosed on the basis of clinical symptoms along with raised serum amylase levels and compatible findings in ultrasonography and CT scan. Two Ranson criteria (lactate dehydrogenase over 350 U/L and aspartate aminotransferase over 250 U/L) were present at admission. The patient was transferred to an intensive care unit (ICU); intravenous crystalloids were prescribed and analgaesics were administered for pain relief. Unexpectedly, 10 h after ICU admission, he presented a cardiac arrest with a non-defibrillate rhythm and died after 40 min of advanced life support. An autopsy was performed and revealed acute necrohaemorrhagic pancreatitis with massive intraperitoneal and retroperitoneal haemorrhage. This case report summarises the epidemiology, pathophysiology and risk factors for fatal bleeding acute pancreatitis." info:eu-repo/semantics/publishedVersion

Since the original Ranson criteria were published more than 30 years ago,[1][1] few topics have engendered as much sustained interest as the prediction of outcome in acute pancreatitis. Acute pancreatitis is a common cause for admission to hospital, accounting for more than 200 000 admissions in the

Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step in improving outcome.Using Classification and Regression Tree (CART) analysis, a clinical scoring system was developed for prediction of in-hospital mortality in AP. The scoring system was derived on data collected from 17,992 cases of AP from 212 hospitals in 2000-2001. The new scoring system was validated on data collected from 18,256 AP cases from 177 hospitals in 2004-2005. The accuracy of the scoring system for prediction of mortality was measured by the area under the receiver operating characteristic curve (AUC). The performance of the new scoring system was further validated by comparing its predictive accuracy with that of Acute Physiology and Chronic Health Examination (APACHE) II.CART analysis identified five variables for prediction of in-hospital mortality. One point is assigned for the presence of each of the following during the first 24 h: blood urea nitrogen (BUN)25 mg/dl; impaired mental status; systemic inflammatory response syndrome (SIRS); age60 years; or the presence of a pleural effusion (BISAP). Mortality ranged from20% in the highest risk group to1% in the lowest risk group. In the validation cohort, the BISAP AUC was 0.82 (95% CI 0.79 to 0.84) versus APACHE II AUC of 0.83 (95% CI 0.80 to 0.85).A new mortality-based prognostic scoring system for use in AP has been derived and validated. The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality.

The ultrasonic findings of 37 patients with acute pancreatitis were related to the severity of the disease according to the Ranson criteria (RK). Pathologic findings of the pancreas were found in every case of severe pancreatitis (oedema, necrosis, conglomerate tumour), whereas in the large group of mild pancreatitis (0-2 RK, n = 26) only 17 patients showed an oedematous swelling of the organ. In 5 patients with mild pancreatitis a tryptic exudation was observed in the peripancreatic area, which must be considered as necrosis in 4 cases because of its long-lasting persistence in follow-up. Five patients in this group showed a rapid reversible ascites representing an effusion due to peritoneal irritation. In the group of severe pancreatitis, peripancreatic exudations were seen in 10 of 11 patients; the higher the severity of disease, the higher was the incidence of ascites, pleural effusions and sonographic signs of ileus.

Determination of severity of acute pancreatitis is important to determine prognosis.(1) the staging of acute pancreatitis by computed tomography and magnetic resonance imaging, (2) the correlation of computed tomography and magnetic resonance severity indices and 3) the correlation of magnetic resonance severity index with C-reactive protein, Ranson score, duration of hospitalization and clinical outcome.Thirty-five patients (median age: 64 (27-89)) were studied. Twenty-two patients had biliary acute pancreatitis.The following examinations were conducted: (1) computed tomography 48 h, 7 and 30 days after admission, (2) magnetic resonance imaging 7 and 30 days after admission, (3) C-reactive protein and 4) Ranson score. Clinical outcome was determined on a scale 0-3 (0: remission, 1: local complications, 2: systemic complications, 3: death).Six of 35 patients (17%) had necrotizing acute pancreatitis. Fifteen of 35 patients (43%) had severe acute pancreatitis according to Ranson criteria. A significant correlation was noted between magnetic resonance severity index and C-reactive protein (r=0.419, p0.005), Ranson score (r=0.431, p0.05), duration of hospitalization (r=0.497, p0.01) and clinical outcome (r=0.420, p0.05). Comparison of the imaging methods showed a significant correlation between magnetic resonance severity index and computed tomography severity index (r=0.887, p0.01).Magnetic resonance imaging is of comparable diagnostic and prognostic value with computed tomography in the staging of acute pancreatitis.