Simplified criteria for predicting the severity of gallstone pancreatitis

Background: There was a need for a simple method of predicting the severity of gallstone pancreatitis soon after admission, to guide the clinician for intensive monitoring, or for transfer to a specialist center. Aim: To validate the role of simplified criteria [white blood cell count (WBC) > 14.5 x 10/dl; blood urea nitrogen (BUN) > 12 mg/dl; random blood sugar (RBS) > 150 mg/dl; pulse > 100/min] in predicting the severity of gallstone pancreatitis at admission. Setting and Design: This prospective study was performed on 54 patients with gallstone pancreatitis admitted in the Department of Surgery of a tertiary hospital. Material and Methods: Fifty-four patients with gallstone pancreatitis were followed for development of complications. Sensitivity analysis of Biliary Ranson > 3, modified Imrie > 3, acute physiology and chronic health evaluation II (APACHE-II) score of > 5, WBC > 14.5 x 10/dl, BUN > 12 mg/dl, RBS > 150 mg/dl, pulse > 100/min and combinations of the four simplified criteria were compared using the Z-test. P < 0.05 was considered statistically significant. Results: Both Biliary Ranson > 3 and modified Imrie > 3 had sensitivity of 96.15% and specificity of 96.43%. Both APACHE-II > 5 and RBS > 150 mg/dl had sensitivity of 88.46%, which is comparable to Biliary Ranson > 3 and modified Imrie > 3. Conclusion: RBS > 150 mg/dl can be used as a simplified prognostic indicator at admission in patients with gall stone pancreatitis and is comparable to Biliary Ranson > 3, modified Imrie > 3, and APACHE-II of > 5.