New tools for optimizing fluid resuscitation in acute pancreatitis

Table 1 Diagnostic criteria for acute pancreatitis with high risk of poor outcome

Criteria for high risk of poor outcome	Hospitalization setting	Organ or system dysfunction
Severe AP: Persistent organ or system dysfunction (> 48 h)	Intensive care	Cardio-vascular: SAP < 90 mmHg despite 20-30 mL/kg fluid loading Respiratory: PaO2 < 60 mmHg
Risk factors for severe AP: Organ or system dysfunction (< 48 h) Lactate > 3 mmol/L Persistent SIRS1 (> 24 h) Pancreatic necrosis Pleural effusion or pulmonary infiltrates BUN > 20 mg/dL or rising BUN Hematocrit > 40% or rising hematocrit Age > 55 yr or comorbid disease or obesity	Intermediate or intensive care	Renal: Creatinine ≥ 2 mg/dL or UO < 0.5 mL/kg of body weight/h for 1 h, despite 20-30 mL/kg fluid loading Hematological: Platelet count < 80000/mm3 or decrease > 50% of initial platelet count Metabolic: pH ≤ 7.30 or base deficit ≥ 5.0 mmol/L in association with lactate > 3 mmol/L Gastro-intestinal: Gastro-intestinal bleeding (> 500 mL/24 h) Neurological: Altered mental status

¹SIRS is defined by the presence of ≥ 3 of the following criteria: Pulse > 90 beats/min, Respirations > 20/min or PaCO₂ < 32 mmHg, Temperature > 38 °C or < 36 °C, WBC count > 12000 or < 4000 cells /mm³ or > 10% immature neutrophils. AP: Acute pancreatitis; BUN: Blood urea nitrogen; PaCO₂: Partial pressure of carbon dioxide in arterial blood; PaO₂: Partial pressure of oxygen in arterial blood; SAP: Systolic arterial pressure; SIRS: Systemic inflammatory response syndrome; UO: Urinary output; WBC: White blood cell.