Criteria for the diagnosis and severity stratification of acute pancreatitis  

作　　者：Makoto Otsuki Kazunori Takeda Seiki Matsuno Yasuyuki Kihara Masaru Koizumi Masahiko Hirota Tetsuhide Ito Keisho Kataoka Motoji Kitagawa Kazuo Inui Yoshifumi Takeyama 

机构地区：[1]Kitasuma Hospital [2]University of Occupational and Environmental Health, Japan, School of Medicine [3]Department of Surgery, National Hospital Organization Sendai Medical Center [4]Towada Shiritsu Central Hospital [5]Department of Gastroenterology, Kitakyushu Central Hospital [6]Kurihara Central Hospital [7]Kumamoto Regional Medical Center, Health Care Center [8]Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University [9]Otsu Municipal Hospital [10]Department of Nutritional Science, Nagoya University of Arts and Sciences [11]Department of Internal Medicine, Second Teaching Hospital,Fujita Health University School of Medicine [12]Department of Surgery, Kinki University School of Medicine

出　　处：《World Journal of Gastroenterology》2013年第35期5798-5805,共8页世界胃肠病学杂志（英文版）

基　　金：Supported by A Grant-in-Aid to the Research Committee on Intractable Pancreatic Diseases provided from the Ministry of Health;Labour and Welfare of Japan

摘　　要：Recent diagnostic and therapeutic progress for severe acute pancreatitis(SAP)remarkably decreased the casemortality rate.To further decrease the mortality rate of SAP,it is important to precisely evaluate the severity at an early stage,and initiate appropriate treatment as early as possible.Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs.Severity can be evaluated by laboratory examinations or by clinical signs,reducing the defect values of the severity factors.Moreover,the severity criteria considered laboratory/clinical severity scores and contrastenhanced computed tomography(CE-CT)findings as independent risk factors.Thus,CE-CT scans are not necessarily required to evaluate the severity of acute pancreatitis.There was no fatal case in mild AP diagnosed by the CE-CT severity score,whereas case-mortality rate in those with SAP was 14.8%.Case-mortality of SAP that fulfilled both the laboratory/clinical and the CE-CT severity criteria was 30.8%.It is recommended,therefore,to perform CE-CT examination to clarify the prognosis in those patients who were diagnosed as SAP by laboratory/clinical severity criteria.Because the mortality rate of these patients with SAP is high,such patients should be transferred to advanced medical units.Recent diagnostic and therapeutic progress for severe acute pancreatitis(SAP) remarkably decreased the casemortality rate. To further decrease the mortality rate of SAP, it is important to precisely evaluate the severity at an early stage, and initiate appropriate treatment as early as possible. Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs. Severity can be evaluated by laboratory examinations or by clinical signs, reducing the defect values of the severity factors. Moreover, the severity criteria considered laboratory/clinical severity scores and contrastenhanced computed tomography(CE-CT) findings as independent risk factors. Thus, CE-CT scans are not necessarily required to evaluate the severity of acute pancreatitis. There was no fatal case in mild AP diagnosed by the CE-CT severity score, whereas case-mortality rate in those with SAP was 14.8%. Case-mortality of SAP that fulfilled both the laboratory/clinical and the CE-CT severity criteria was 30.8%. It is recommended,therefore, to perform CE-CT examination to clarify the prognosis in those patients who were diagnosed as SAP by laboratory/clinical severity criteria. Because the mortality rate of these patients with SAP is high, such patients should be transferred to advanced medical units.

关 键 词：Severe acute PANCREATITIS SEVERITY SCORE SCORING system PROGNOSTIC factors Case-mortality 

分 类 号：R576[医药卫生—消化系统]