Simple admission criteria (white blood cell count, ≥14.5 × 109/L; blood urea nitrogen level, ≥4.3 mmol/L [≥12 mg/dL]; heart rate, ≥100 beats per minute; and serum glucose level, ≥8.3 mmol/L [≥150 mg/dL]) are better predictors of severe complications of gallstone pancreatitis than an Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 5 or greater, a modified Imrie (Glasgow) score of 3 or greater, and a biliary Ranson score of 3 or greater.
A prospective consecutive case study.
A university-affiliated, urban, public hospital.
Ninety-two consecutive patients (77 women and 15 men, aged 18 to 76 years [mean age, 39 years]) with gallstone pancreatitis. Seventy-seven patients were Hispanic.
Main Outcome Measures
Major local and systemic complications requiring intensive care unit care, and death.
Fourteen patients (15%) had severe complications with a mortality of 2%. On univariate analysis, a white blood cell count of 14.5 × 109/L or more (P =.03), a serum glucose level of 8.3 mmol/L or more (≥150 mg/dL) (P<.001), an APACHE II score of 5 or greater (P =.008), a modified Imrie score of 3 or greater (P<.001), and a biliary Ranson score of 3 or greater (P =.03) were statistically associated with the development of severe complications; whereas a blood urea nitrogen level of 4.3 mmol/L or more (≥12 mg/dL) and a heart rate of 100 beats per minute or more were not. On multivariate analysis, only a serum glucose level of 8.3 mmol/L or more (≥150 mg/dL) was predictive of adverse events (P<.001).
Glucose level (≥8.3 mmol/L [≥150 mg/dL]) is the best single admission predictor of severe complications of gallstone pancreatitis and is superior to an APACHE II score of 5 or greater, a modified Imrie score of 3 or greater, and a biliary Ranson score of 3 or greater.