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.

Table 2 Univariate and multivariate analysis showing association of each prognostic factor with acute pancreatitis-related death

	OR (95%CI)	P value
Univariate analysis
BE ≤ -3 mEq/L or shock	12.1 (6.8-21.1)	< 0.0001
PaO2 ≤ 60 mmHg or respiratory failure	11.1 (5.7-20.9)	< 0.0001
BUN ≥ 40 mg/dL (or Cr ≥ 2 mg/dL or oliguria)	14.9 (8.3-26.4)	< 0.0001
Elevation of LDH (twice or more than UNL)	4.2 (2.3-7.4)	< 0.0001
Platelet count ≤ 100000/μL	4.2 (1.6-9.5)	0.007
Serum calcium ≤ 7.5 mg/dL	14.1 (7.2-26.8)	< 0.0001
CRP ≥ 15 mg/dL	3.6 (1.9-6.7)	0.0003
Meeting 3 or more SIRS criteria	8.4 (4.7-14.8)	< 0.0001
Age ≥ 70 yr	3.2 (1.8-5.5)	< 0.0001
Multivariate analysis
BE ≤ -3 mEq/L or shock	2.8 (1.3-6.1)	0.012
PaO2 ≤ 60 mmHg or respiratory failure	1.9 (0.8-4.4)	0.130
BUN ≥ 40 mg/dL (or Cr ≥ 2 mg/dL or oliguria)	3.8 (1.8-7.8)	0.0008
Elevation of LDH (twice or more than UNL)	1.5 (0.7-3.0)	0.280
Platelet count ≤ 100000/μL	1.8 (0.6-4.9)	0.300
Serum calcium ≤ 7.5 mg/dL	2.5 (0.99-6.1)	0.051
CRP ≥ 15 mg/dL	1.0 (0.4-2.2)	0.980
Meeting 3 or more SIRS criteria	2.3 (1.0-4.7)	0.038
Age ≥ 70 yr	3.5 (1.9-6.6)	< 0.0001

BE: Base excess; BUN: Blood urea nitrogen; CRP: C-reactive protein; LDH: Lactate dehydrogenase; SIRS: Systemic inflammatory response syndrome; UNL: Upper normal limit.

Table 3 Comparison of the characteristics of patients with or without walled-off necrosis in 2011 survey n (%)

	WON (+), n = 124	WON (-), n = 226	P value
Median age (IQR)	59 (50-70)	62.5 (50-74)	0.1901
Male sex	102 (82.3)	164 (72.6)	0.0422
Severe pancreatitis	56 (45.2)	65 (28.8)	0.0022
Severity score ≥ 3	19 (15.3)	23 (10.2)	0.1602
Severity score < 3	105 (84.7)	203 (89.8)
CT grade ≥ 2	51 (41.1)	54 (23.9)	0.0012
CT grade < 2	51 (41.1)	137 (60.6)
CT grade unknown	22 (17.7)	35 (15.5)
Etiology
Biliary	23 (18.6)	42 (18.6)	0.9802
Alcohol	52 (41.9)	96 (42.5)
Idiopathic	20 (16.1)	37 (16.4)
Others	26 (21.0)	43 (19.0)
Unknown	3 (2.4)	8 (3.5)

¹t-test;

²χ² test. CT: Computed tomography; IQR: Interquartile range; WON: Walled-off necrosis.