Prognostic Factors For Acute Pancreatitis

A 35-year-old alcoholic man is admitted with nausea, vomiting, and abdominal pain that radiates to the back. He has had several previous episodes of pancreatitis presenting with the same symptoms. Which of the following laboratory values suggests a poor prognosis in this patient?

a. Elevated serum lipase
b. Elevated serum amylase
c. Leukocytosis of 20,000/μm
d. Diastolic blood pressure greater than 90 mm Hg
e. Heart rate of 100 beats/minute

Answer And Discussion:


The answer is c. ( Leukocytosis of 20,000/μm.)

Prognostics Factors For Acute Pancreatitis:
The Ranson criteria are used to determine prognosis in acute pancreatitis. Factors that adversely affect survival include

• age greater than 55 years, 
• leukocytosis greater than 16, 000/μm,
• glucose greater than 200 mg/dL,
•  LDH greater than 400 U/L, and 
• AST greater than 250 U/L. 

After the initial 48 hours, a decrease in hematocrit, hypocalcemia, hypoxemia, an increase in BUN, and hypoalbuminemia predict a poor prognosis.
Hypotension with systolic BP less than 90 mm Hg is also a poor prognostic sign; diastolic hypertension is not correlated with prognosis.
Although serum amylase and lipase elevations are important in the diagnosis of pancreatitis, the degree of elevation is not prognostic.
Tachycardia is frequently associated with the pain of pancreatitis but is not a risk factor in the Ranson criteria.