Glasgow Pancreatitis Score Calculator

How does this Glasgow pancreatitis score calculator work?

This health tool screens patients for severe pancreatitis based on results from 7 laboratory exams performed in the first 48 hours after admission for pancreatitis. Another name used for this type of assessment is Imrie’s criteria.

Unlike some of the criteria available for pancreatitis, this one is applicable to both biliary and alcoholic pancreatitis.

The Glasgow pancreatitis score calculator consists of the 8 items that are known to form the acronym pancreas:

■ PaO₂ (Arterial PO₂ on room air <8 kPa (60 mmHg);

■ Age >55 years;

■ Neutrophils (WBC count) >15 x 10⁹/L (15 x 10³/microlitre);

■ Calcium <2 mmols/L (8 mg/dL);

■ Renal function (Serum urea nitrogen) >16.1 mmols/L (45 mg/dL);

■ Enzymes (Serum LDH) >600 units/L;

■ Albumin <32 g/L (3.2 g/dL);

■ Sugar (Blood glucose) >10.0 mmols/L (180 mg/dL).

Glasgow pancreatitis score interpretation

There are 8 parameters in Imrie’s criteria, each of them, if present, weighing 1 point from the total of 8 possible.

Scores above 2 are consistent with high likelihood of severe pancreatitis. Scores of 2 and below are not consistent with severe pancreatitis, however, depending on the severity of the independent symptoms, the patient should continue investigations. Patients scoring more than 3 need to be transferred to intensive therapy units.

For each of the scores there are associated mortality risk percentages as follows:

■ Score 0 to 2: 2% predicted mortality;

■ Score 3 to 4: 15% predicted mortality;

■ Score 5 to 6: 40% predicted mortality;

■ Score 7 to 8: 100% predicted mortality.

Acute pancreatitis diagnosis and mortality assessment tools

Aside from Imrie’s criteria, there are other tools based on laboratory values and patient data upon admission that predict complication risk or allow mortality risk stratification:

■ The BISAP pancreatitis score calculator determines risk of complications in the first 24 hours from admission with acute pancreatitis.

■ Computed tomography severity index (CTSI) / (Balthazar score) determines the percentage of necrosis and is used in CT grading.

■ The Ranson criteria for pancreatitis calculator uses a mortality risk clinical prediction rule at admission and within 24h for severity.

■ Apache II, the acute physiology and chronic health examination can also be used for patients with pancreatitis.

Pancreatitis medical considerations

Acute pancreatitis is the common cause of 3% of admissions of abdominal pain with causes ranging from gallstones, ethanolic (alcoholic pancreatitis), trauma, steroid abuse, hypercalcemia, hypothermia, estrogens, NSAIDS abuse, viral (mumps, coxsackie, hepatitis) to autoimmune disease (Systemic lupus).

Presentation consists in epigastric or upper abdominal pain with sudden onset, hemodynamic instability, tachycardia, respiratory distress, gallstones, fever, vomiting and in some cases EtoH or drug usage history.

The main investigations performed in the emergency room consist of:

■ Blood: FBC, UEC, CMP, BSL, LFT, CRP, lipase/amylase, ABG, cultures;

■ Urine: Bilirubin. Urinary trypsinogen activation peptyde;

■ ECG: non-specific ST-T wave changes visualized;

■ Imaging: CXR, AXR, CT.

Differential diagnosis is made with SB perforation, ruptured aortic aneuryisms, AMI, ectopic pregnancy, mesenteric ischaemia or perforated DU.

Late intervention with medication or surgery if necessary may lead to complications such as:

■ Pancreatic necrosis – heightened mortality risk if not surgical debridement;

■ Pancreatic abscess;

■ Acute pseudocyst – consisting of pancreatic juice in fibrous capsule;

■ Pulmonary oedema;

■ Pleural effusions;

■ Hypovolaemia – followed by subsequent shock;

■ Disseminated intravascular coagulopathy (DIC).

References

1) Williams M, Simms HH. (1999) Prognostic usefulness of scoring systems in critically ill patients with severe acute pancreatitis. Crit Care Med; 27(5):901-7.

2) Blamey SL, Imrie CW, O'Neill J, Gilmour WH, Carter DC. (1984) Prognostic factors in acute pancreatitis. Gut; 5(12):1340-6.

3) Leese T, Shaw D. (1988) Comparison of three Glasgow multifactor prognostic scoring systems in acute pancreatitis. Br J Surg; 75(5):460-2.

4) Meek K, Toosie K, Stabile BE, Elbassir M, Murrell Z, Lewis RJ, Chang L, de Virgilio C. (2000) Simplified admission criterion for predicting severe complications of gallstone pancreatitis. Arch Surg; 135(9):1048-52; discussion 1052-4.

5) Taylor SL, Morgan DL, Denson KD, Lane MM, Pennington LR. (2005) A comparison of the Ranson, Glasgow, and APACHE II scoring systems to a multiple organ system score in predicting patient outcome in pancreatitis. Am J Surg; 189(2):219-22.