Modified Marshall Score Calculator

How does the modified Marshall score calculator work?

This health tool is based on the Marshall score for organ failure and the 2012 revised Atlanta classification of acute pancreatitis. Based on that, the status of the three organ systems: respiratory, cardiovascular and renal, can be used to determine the existence of organ failure, in this case, of acute pancreatitis.   

The three items in the modified Marshall score calculator are:

■ Respiratory status – evaluated through PaO₂:FiO₂. This can also be estimated for non-ventilated patients.

■ Renal status – evaluated through serum creatinine values, measured in either mg/dL or μmol/L.

■ Cardiovascular status – evaluated through systolic blood pressure in mmHg and in some cases by the comparison of pH (values below 7.2 and 7.3).

The following table introduces the modified Marshall score:

The main determinant of the severity of acute pancreatitis is the presence and duration of organ failure. Presence is defined according to the modified Marshall score as a score of 2 in at least one of the three organ systems. If two or more systems are affected, then the term multiple organ failure is used. Duration is defined through one of the following two terms:

■ Transient organ failure – when organ failure resolves within 48h. In the case of AP, it indicates moderately severe acute pancreatitis.

■ Persistent organ failure – when organ failure persists for more than 48h. In the case of AP, it indicates severe acute pancreatitis.

When calculated for patients with pre-existing chronic renal failure, the extent of further deterioration needs to be compared with the baseline renal function, although there is no formal correction for baseline serum creatinine (considered at ≥1.4 mg/dL or ≥134 μmol/l).

The main advantage of the use of the three organ systems stays in the administration simplicity and in the fact that it has a universal applicability.

Atlanta classification of AP

The original Atlanta classification and the subsequent revision of 2012 have reached an international consensus in the classification of AP and also in the clinical and radiologic evidence of acute pancreatitis. This helps in research and in the standardized reporting of cases.

Mild acute pancreatitis is defined by:

■ Absence of organ failure, local or systemic complications;

■ Patient discharged 3 to 7 days from illness onset;

■ Normally, pancreatic imaging is not required.

Moderately severe pancreatitis is defined by the presence of one or more of:

■ Transient organ failure;

■ Systemic complications (e.g. chronic lung disease exacerbated);

■ Local complications (e.g. fever, abdominal pain).

Severe acute pancreatitis is defined by persistent one organ or multiorgan failure for more than 48 hours.

There are other scores available that determine the severity of AP, such as the Balthazar score which uses the Balthazar grading and level of pancreatic necrosis or the Glasgow pancreatitis score which looks at the first 24 hour investigations.

References

1) Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. (1995) Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med; 23(10):1638-52.

2) Nawaz H, Mounzer R, Yadav D, Yabes JG, Slivka A, Whitcomb DC, Papachristou GI. (2013) Revised Atlanta and determinant-based classification: application in a prospective cohort of acute pancreatitis patients. Am J Gastroenterol; 108(12):1911-7.

3) Tenner S1, Baillie J, DeWitt J, Vege SS; American College of Gastroenterology. (2013) American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol; 108(9):1400-15.

4) Banks PA, Bollen TL, Dervenis C, et al. (2013) Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut; 62(1):102-11.

5) Carioca AL, Jozala DR, de Bem LO, Rodrigues JM. (2015) Severity assessment of acute pancreatitis: applying Marshall scoring system. Rev Col Bras Cir; 42(5):325-7.

6) Cho JH, Kim TN, Chung HH, Kim KH. (2015) Comparison of scoring systems in predicting the severity of acute pancreatitis. World J Gastroenterol; 21(8): 2387–2394.