FAILURE OF THE HONG-KONG CRITERIA TO PREDICT THE SEVERITY OF ACUTE-PANCREATITIS

Conclusion. The results of the present study demonstrate that the HK c riteria do not provide effective prediction of severity. Background. F an et al. (1) have reported previously that a blood urea (BU) >7.4 mmo l/L and/or glucose (BG) >11 mmol/L at the time of admission to hospita l detects a severe attack of acute pancreatitis with a sensitivity of 76% and specificity of 75%. However, a similar study conducted in the West of Scotland did not confirm these findings (sensitivity 33% and s pecificity 83%). The reason underlying this discrepancy in prediction is unclear, but it may be because of differences in the nature of acut e pancreatitis between Asian and Western populations. Aims. In this st udy we examined the predictive ability of the Hong Kong (HK) criteria in a patient population similar to that studied by Fan et al. Patients and Methods. A consecutive series of 130 patients experienced 135 att acks of acute pancreatitis, One-hundred-and-four (77%) attacks were mi ld and 31 (23%) severe (including 12 [9.0%] deaths). Eighty-nine (66%) episodes had a biliary etiology. In 19 (14%) of these episodes, the g allstones had a primary ductal origin being associated with recurrent pyogenic cholangitis. Results. Median admission BU concentrations were 5.2 mmol/L (range 3.6-32.1 mmol/L) for the mild group and 7.6 mmol/L (range 3.6-28.8 mmol/L) for the severe group. Corresponding values of BG were 7.1 mmol/L (range 2.1-17.9 mmol/L) and 8.4 mmol/L (range 3.6-2 8.8 mmol/L), respectively. Differences in admission BU concentrations between patients with mild and severe episodes were significant (p = 0 .0001). However, differences in BG concentrations were not (p = 0.16). In the severe group, 14 patients had BU and four patients BG concentr ations above the cut-off values. The HK criteria predicted severe acut e pancreatitis with a sensitivity of 52% and specificity of 80%. These results compare with values of 79 and 56% for the Ranson criteria and 83 and 60% for the Glasgow score. The best prediction was provided by the APACHE II score 24 h post admission (sensitivity 79%, specificity 82%).