Simplified admission criterion for predicting severe complications of gallstone pancreatitis

Abstract

Hypothesis: Simple admission criteria (white blood cell count, ≥14.5 x 109/L; blood urea nitrogen level, ≥4.3 mmol/L [≥ 12 mg/dL]; heart rate, ≥ 100 beats per minute; and serum glucose level, ≥8.3 mmol/L [≥150 mg/dL]) are better predictors of severe complications of gallstone pancreatitis than an Acute Physiology 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 score 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 patients were Hispanic. Main Outcome Measures: Major local and systemic complications requiring intensive 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 109/L or more (P=.03), a serum glucose level of 8.3 mmol/L or more (≥ 150 mg/dL) (P