Management of acute pancreatitis in Japan: Analysis of nationwide epidemiological survey

Table 1 The severity scoring criteria of acute pancreatitis defined by the Japanese Ministry of Health, Labor and Welfare (2008)

Prognostic factor
Base excess ≤ -3 mEq/L or shock (systolic blood pressure < 80 mmHg)
PaO2 ≤ 60 mmHg or respiratory failure (needing respirator)
BUN ≥ 40 mg/dL (or Cr ≥ 2 mg/dL) or oliguria (< 400 mL/d even after fluid therapy)
Elevation of LDH twice or more than upper normal limit
Platelet count ≤ 100000/μL
Serum calcium ≤ 7.5 mg/dL
CRP ≥ 15 mg/dL
Meeting 3 or more SIRS criteria (body temperature > 38 °C or < 36 °C, heart rate > 90/min, respiratory rate > 20/min or PaCO2 < 32 torr, WBC > 12000/μL or < 4000/μL or > 10% immature leukocyte)
Age ≥ 70 yr
Classification of CT grade by contrast-enhanced CT
Factor 1: Extent of extrapancreatic inflammation
To the anterior pararenal extraperitoneal space	0 point
To the root of mesocolon	1 point
Further than inferior pole of kidney	2 points
Factor 2: Less-enhanced region of pancreas (divided into three segments; head, body and tail)
Localized within one segment or limited to peripheral pancreas	0 point
Occupies two segments	1 point
Occupies more than two segments	2 points
Sum of factor 1 and factor 2 ≤ 1	grade 1
Sum of factor 1 and factor 2 = 2	grade 2
Sum of factor 1 and factor 2 ≥ 3	grade 3

Severe acute pancreatitis is defined as fulfilling 3 or more criteria of prognostic factors or revealing CT grade 2 or more. BUN: Blood urea nitrogen; Cr: Creatinine; CRP: C-reactive protein; CT: Computed tomography; LDH: Lactate dehydrogenase; SIRS: Systemic inflammatory response syndrome; WBC: White blood cells.