PANCREATITIS PROGNOSIS

A number of systems have been developed to help determine the prognosis of an individual with pancreatitis. A very basic evaluation of a patient will allow some prediction to be made based on the presence of dying pancreatic tissue (necrosis) and bleeding. When necrosis and bleeding are present, as many as 50% of patients may die.

More elaborate systems have been created to help determine the prognosis of patients with pancreatitis. The most commonly used system identifies 11 different signs (Ranson's signs) that can be used to determine the severity of the disease. The first five categories are evaluated when the patient is admitted to the hospital:

• age over 55 years
• blood sugar level over 200 mg/Dl
• serum lactic dehydrogenase over 350 IU/L (increased with increased breakdown of blood, as would occur with internal bleeding, and with heart or liver damage)
• AST over 250 mu (a measure of liver function, as well as a gauge of damage to the heart, muscle, brain, and kidney)
• white blood count over 16,000 u L

The next six of Ranson's signs are reviewed 48 hours after admission to the hospital. These are:

• greater than 10% decrease in hematocrit (a measure of red blood cell volume)
• increase in BUN greater than 5 mg/dL (blood urea nitrogen, an indicator of kidney function)
• blood calcium less than 8 mg/dL
• PaO2 less than 60 mm Hg (a measure of oxygen in the blood)
• base deficit greater than 4 mEg/L (a measure of change in the normal acidity of the blood)
• fluid sequestration greater than 6 L (an estimation of the quantity of fluid that has leaked out of the blood circulation and into other body spaces)

Once a doctor determines how many of Ranson's signs are present and gives the patient a score, the doctor can better predict the risk of death. The more signs present, the greater the chance of fatal complications. A patient with less than three positive Ranson's signs has a 95% survival rate. A patient with three to four positive Ranson's signs has a 80-85% survival rate.

The results of a CT scan can also be used to predict the severity of pancreatitis. Slight swelling of the pancreas indicates mild illness. Significant swelling, especially with evidence of destruction of the pancreas and/or fluid build-up in the abdominal cavity, indicates more severe illness. With severe illness, there is a worse prognosis.