Glasgow Pancreatitis Score

Assesses the severity of pancreatitis within 48 hours from admission.

Read more about the items included in the score, how are weighted and about how the result is interpreted, in the text below the calculator.


The Glasgow pancreatitis score evaluates how severe pancreatitis is, based on seven laboratory investigations performed in the first 48 hours after hospital admission and on a risk weighting based on patient age.

The score is also known as Imrie’s criteria and applies to both pancreatitis of biliary and alcoholic source.


Each of the 8 items in the score, when present, is awarded 1 point.

Therefore, the Glasgow pancreatitis score ranges from 0 to 8, where scores above 2 are indicative of high likelihood of severe pancreatitis (with patients scoring above 3 being likely to require transfer to intensive care units).

The following table associates a predicted mortality risk with the possible scores:

Glasgow pancreatitis score Predicted mortality
0 - 2 2%
3, 4 15%
5, 6 40%
7, 8 100%

1Age >55 years
2Serum albumin <32 g/L (3.2 g/dL)
3Arterial PO2 on room air <8 kPa (60 mmHg)
4Serum calcium <2 mmols/L (8 mg/dL)
5Blood glucose >10.0 mmols/L (180 mg/dL)
6Serum LDH >600 units/L
7Serum urea nitrogen >16.1 mmols/L (45 mg/dL)
8WBC count >15 x 109/L (15 x 103/microlitre)
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Pancreatitis score items

This is a medial decision tool that helps clinicians screen severe cases of acute pancreatitis.

It is based on patient age and determinations from 7 routine laboratory tests performed within 24 hours from admission for patients who present with acute abdominal pain.

The score is also named after one of its creators: Imrie’s Criteria.

What is special about this pancreatitis score, is that it can be applied to both biliary and alcoholic pancreatitis.

The 8 severity risk factors accounted for in the score are:

■ Age >55 years;

■ Serum albumin <32 g/L (3.2 g/dL);

■ Arterial PO2 on room air <8 kPa (60 mmHg);

■ Serum calcium <2 mmols/L (8 mg/dL);

■ Blood glucose >10.0 mmols/L (180 mg/dL);

■ Serum LDH >600 units/L;

■ Serum urea nitrogen >16.1 mmols/L (45 mg/dL);

■ WBC count >15 x 109/L (15 x 103/microlitre).

The 8 items in the Glasgow pancreatitis score calculator are known to form the acronym pancreas: partial pressure oxygen, age, neutrophils, calcium, renal function, enzymes, albumin and sugar.

 

Scoring method

Each of the 8 items in the score are awarded 1 point when present, for example when “Serum LDH >600 units/L”.

The total score ranges from 0 to 8, the higher the score, the greater the AP severity.

There is a cut off for increased likelihood of severity at 2 points, where every value above indicates severe AP.

Scores above 3 also indicate that the patient is likely to require admission to ICU.

The table below introduces the correlation between scores and mortality risk:

Glasgow pancreatitis score Predicted mortality
0 - 2 2%
3, 4 15%
5, 6 40%
7, 8 100%
 

About the study

The Glasgow pancreatitis score was created by Blamey et al. in 1984 as a prognostic factor system that predicts the severity of AP.

The study initially relied on a nine factor system and included 405 episodes of acute pancreatitis occurring in a seven year period.

From this sample, in 72% of cases, severity was assessed accurately by the score.

It was found that 131 episodes were scored with 3 or more points, out of which 31% were severe.

From the rest of 274 episodes that were scored with less than 3 points, only 8% were severe.

When dropping the one risk factor that was found unrelated to severity, the system (the 8 item Glasgow pancreatitis score) predicted severity correctly in 79% of cases.

 

Acute pancreatitis explained

AP accounts for 3% of abdominal pain admissions. The most common causes are:

■ Ethanolic origin (alcoholic pancreatitis);

■ Gallstones;

■ Trauma;

■ Steroid abuse;

■ NSAIDs abuse;

■ Hypercalcemia;

■ Viral causes (coxsackie, hepatitis);

■ Systemic lupus.

Presentation consists in epigastric or upper abdominal pain with sudden onset, tachycardia, respiratory distress, hemodynamic instability, fever or vomiting.

The table below summarises the main diagnostic investigations from ER:

Sample / Investigation Laboratory test
Blood FBC, UEC, CMP, BSL, LFT, CRP, lipase/amylase, ABG, cultures
Urine Bilirubin, Urinary trypsinogen activation peptyde
ECG Non-specific ST-T wave changes visualized
Imaging CXR, AXR, CT

Differential diagnosis may be required with the following: SB perforation, AMI, ruptured aortic aneurysms, ectopic pregnancy, mesenteric ischaemia or perforated DU.

AP is one of the conditions that lead to serious complications if not intervened in time with medication or surgery.

Pancreatic abcesses or necrosis heighten mortality risk if surgical debridement does not take place.

Pulmonary edema or pleural effusions may also occur, along with hypovolemia and shock or disseminated intravascular coagulopathy (DIC).

 

Diagnosing and predicting mortality risk in AP

There are several medical tools available to specialists which are based on laboratory results and patient data readily available upon admission.

These are used either to diagnose acute pancreatitis, to determine its severity or predict mortality risk.

The table below introduces four examples of such decision making tools:

BISAP pancreatitis score Stratifies risk of complications in the first 24 hours from admission with AP.
Computed tomography severity index (CTSI) / (Balthazar score) Determines the percentage of necrosis in pancreatitis and is used in CT grading.
The Ranson criteria for pancreatitis This is a mortality risk clinical predictor for admission and within 24h.
Apache II score This is an acute physiology and chronic health examination that can be applied in pancreatitis too.
 

Original source

Blamey SL, Imrie CW, O'Neill J, Gilmour WH, Carter DC. Prognostic factors in acute pancreatitis. Gut. 1984; 5(12):1340-6.

Validation

Mounzer R, Langmead CJ, Wu BU, Evans AC, Bishehsari F, Muddana V, Singh VK, Slivka A, Whitcomb DC, Yadav D, Banks PA, Papachristou GI. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology. 2012; 142(7):1476-82.

Other references

1. Taylor SL, Morgan DL, Denson KD, Lane MM, Pennington LR. A comparison of the Ranson, Glasgow, and APACHE II scoring systems to a multiple organ system score in predicting patient outcome in pancreatitis. Am J Surg. 2005; 189(2):219-22.

2. Meek K, Toosie K, Stabile BE, Elbassir M, Murrell Z, Lewis RJ, Chang L, de Virgilio C. Simplified admission criterion for predicting severe complications of gallstone pancreatitis. Arch Surg. 2000; 135(9):1048-52; discussion 1052-4.


App Version: 1.0.1

Coded By: MDApp

Specialty: Gastroenterology

System: Digestive

Objective: Evaluation

Type: Score

No. Of Items: 8

Year Of Study: 1984

Article By: Denise Nedea

Published On: May 24, 2017 · 07:39 AM

Last Checked: May 24, 2017

Next Review: May 24, 2018