Continuous regional arterial infusion therapy with gabexate mesilate for severe acute pancreatitis

Table 1 Criteria for grading the severity of acute pancreatitis in Japan[4]

Prognostic factors	Clinical signs	Laboratory data
Prognostic factor I (2 points for each positive factor)	Shock	BE ≤ -3 mmol/L
	Respiratory failure	Ht ≤ 30% (after hydration)
	Mental disturbance	BUN ≥ 40 mg/dL or creatinine ≥ 2.0 mg/dL
	Severe infection
	Hemorrhagic diathesis
Prognostic factor II (1 points for each positive factor)		PaO2 ≤ 60 mmHg (room air)
		FBS ≥ 200 mg/dL
		Total protein ≤ 60 g/L
		LDH ≥ 700 IU/L
		Ca ≤ 7.5 mg/dL
		Prothrombin time ≥ 15 s
		Platelet count ≤ 1 × 105/mm3
		CT grade IV or V
Prognostic factor III	SIRS score ≥ 3 (2 points)
	Age ≥ 70 yr (1 point)

BE: Base excess; Ht: Hematocrit; BUN: Blood urea nitrogen; FBS: Fasting blood sugar; LDH: Lactate dehydrogenase; SIRS: Systemic inflammatory response syndrome. CT grade IV or V: Presence of diffuse and uneven density in the pancreatic parenchyma or the presence of inflammatory changes extending beyond the border of the pancreas. Severity score: Sum of the points for the positive prognostic factors is defined as the severity score. Standardized criteria: Severe, presence of more than one prognostic factor I, and/or the presence of more than two prognostic factor II (severity score ≥ 2 points); Moderate, presence of one prognostic factor II (severity score = 1 point); Mild, acute pancreatitis without prognostic factor I or II (severity = 0 point).

Table 2 Stage classification of acute pancreatitis and mortality rate in 2003 in Japan[4]

Stage	Severity score	Severity	No. of patients(%)	Died	Mortality rate (%)
Stage 0	0 point	Mild	943 (53.3)	1	0.1
Stage 1	1 point	Moderate	280 (15.8)	2	0.7
Stage 2	2-8 points	Severe I	455 (25.7)	17	3.7
Stage 3	9-14 points	Severe II	63 (3.6)	16	25.4
Stage 4	≥ 15 points	Most severe	27 (1.5)	16	59.3
Total			1786 (100)	52	2.9

In 2004, nationwide survey of patients with acute pancreatitis in Japan who visited the hospitals in the year 2003 (from January 1 to December 31) was performed by stratified random sampling method. From the first survey, the total number of patients treated for acute pancreatitis in Japan in the year 2003 was estimated as 35 300 (95% confidence interval, 30 500-40 000). Clinical records of 1768 patients with acute pancreatitis were obtained in the second survey for analysis of etiology and outcome. Number of patients who died of acute pancreatitis or related complications.

Table 3 The clinical features of patients

	CRAI group (n = 9)	Non-CRAI group (n = 9)
Mean age	48.0 ± 13.4	59.8 ± 15.1
Gender (male/female)	9/0	4/5
Cause of pancreatitis
Alcoholic	5	3
Biliary	1	4
Hyperlipidemia	1	0
post-ERCP	1	1
Idiopathic	1	1
Severity score
Mean score (range)	4.0 (2-7)	3.6 (2-7)