Glasgow Pancreatitis Score

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:

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:

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:

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.