Simplified admission criterion for predicting severe complications of gallstone pancreatitis.

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Abstract
GALLSTONES ARE the most common cause of acute pancreatitis worldwide.1 Although most patients recover uneventfully, a subgroup go on to develop severe complications. Numerous scoring systems, including those of Ranson and colleagues2,3 and Imrie and colleagues,4-6 have been devised in an effort to predict which patients will manifest severe pancreatitis. A modified Imrie (Glasgow) or biliary Ranson score of 3 or greater has been associated with severe pancreatitis. These scoring systems are hampered by the fact that they require measurement of multiple factors over a 48-hour period. In a previous study, we identified 5 variables present on admission to the hospital that predicted the development of complications of severe gallstone pancreatitis (GP) necessitating care in the intensive care unit (ICU).7 These factors included the following admission values: white blood cell count of 14.5 × 109/L or more, blood urea nitrogen (BUN) level of 4.3 mmol/L or more (≥12 mg/dL), heart rate of 100 beats per minute or more, serum glucose level of 8.3 mmol/L or more (≥150 mg/dL), and an Acute Physiology and Chronic Health Evaluation (APACHE) II score of 5 or greater. This study prospectively validated these admission criteria in a new group of patients with GP and determined if any of these predictors of severe complications of GP are superior to an APACHE II score of 5 or greater, a modified Imrie score of 3 or greater, or a biliary Ranson score of 3 or greater.