The use of the peripheral leukocyte count and chest X-rays in early assessment of the severity of acute pancreatitis in comparison with the Ranson score system

Background. To evaluate the efficacy of the peripheral leukocyte count and chest X-rays as an index which could be used in the early assessment of the severity of acute pancreatitis in an Emergency Room. Methods. We prospectively evaluated the peripheral leukocyte count and the findings of chest X-rays in 181 consecutive patients (102 males, 79 females , mean age 61 years, range 16-97) who were admitted to our Emergency Depart ment with acute pancreatitis. One hundred twenty six patients had mild panc reatitis and 55 had severe pancreatitis. The peripheral leukocyte count and the chest X-rays were evaluated in all patients upon admission. The Ranson criteria were also assessed. Results, Using a cut off value of 13,000/mm(3), 45% of the patients with se vere pancreatitis and 17% of those with mild acute pancreatitis had a perip heral leukocyte count greater than 13,000/mm3. Pleural or pulmonary alterat ions observed on chest X-ray were found in 66% of patients with severe panc reatitis and in 2% of those with mild acute pancreatitis. A peripheral leuk ocyte count greater than 13,000/mm3 and/or pleural or pulmonary alterations present on chest X-ray were found in 78% of the patients with severe pancr eatitis and in 19% of those with mild pancreatitis. The Ranson criteria gre ater than or equal to three were found in 45% of the patients with severe a cute pancreatitis and in 16% of those with the mild form of the disease. Th e positive predictive value was 92% for the presence of alterations on the chest X-rays, 64% for the alteration of at least one of the abnormal findin gs on the chest X-ray and a peripheral leukocyte count greater than 13,000/ mm3, 56% for a peripheral leukocyte count greater than 13,000/mm(3), and 54 % for the presence of Ranson criteria greater than or equal to three. The n egative predictive values were similar. Conclusions. The presence of pleural or pulmonary alterations on chest X-ra ys may be useful in the Emergency Room for the early identification of pati ents with severe acute pancreatitis.