Simplified admission criterion for predicting severe complications of gallstone pancreatitis

Hypothesis: Simple admission criteria (white blood cell count, greater than or equal to 14.5 x 10(9)/L; blood urea nitrogen level, greater than or equ al to 4.3 mmol/L [greater than or equal to 12 mg/dL]; heart rate, greater t han or equal to 100 beats per minute; and serum glucose level, greater than or equal to 8.3 mmol/L [greater than or equal to 150 mg/dL]) are better pr edictors of severe complications of gallstone pancreatitis than an Acute Ph ysiology and Chronic Health Evaluation II (APACHE II) score of 5 or greater , a modified Imrie (Glasgow) score of 3 or greater, and a biliary Ranson sc ore of 3 or greater. Design:A prospective consecutive case study. Setting: A university-affiliated, urban, public hospital. Patients: Ninety-two consecutive patients (77 women and 15 men, aged 18 to 76 years [mean age, 39 years]) with gallstone pancreatitis. Seventy-seven p atients were Hispanic. Main Outcome Measures: Major local and systemic complications requiring int ensive care unit care, and death. Results: Fourteen patients (15%) had severe complications with a mortality of 2%. On univariate analysis, a white blood cell count of 14.5 x 10(9)/L o r more (P=.03), a serum glucose level of 8.3 mmol/L or more (greater than o r equal to 150 mg/dL) (P<.001), an APACHE II score of 5 or greater (P=.008) , a modified Imrie score of 3 or greater (P<.001), and a biliary Ranson sco re of 3 or greater (P=.03) were statistically associated with the developme nt of severe complications; whereas a blood urea nitrogen level of 4.3 mmol /L or more (greater than or equal to 12 mg/dL) and a heart rate of 100 beat s per minute or more were not. On multivariate analysis, only a serum gluco se level of 8.3 mmol/L or more (greater than or equal to 150 mg/dL) was pre dictive of adverse events (P<.001). Conclusions: Glucose level(greater than or equal to 8.3 mmol/L [greater tha n or equal to 150 mg/dL]) is the best single admission predictor of severe complications of gallstone pancreatitis and is superior to an APACHE II sco re of 5 or greater, a modified Imrie score of 3 or greater, and a biliary R anson score of 3 or greater.