Criteria

Establish the diagnosis of acute pancreatitis through a combination of clinical, laboratory, and imaging criteria.

Severity scoring tools such as APACHE II and Glasgow have limited value and are not generally recommended by evidence-based guidelines.[9][25][54][57][58][59]​​[60]​​

International Association of Pancreatology/American Pancreatic Association/American College of Gastroenterology criteria[9][54]

Two out of three of the following criteria must be met for the diagnosis of acute pancreatitis:

  • Clinical (upper abdominal pain)

  • Laboratory (serum lipase or amylase >3 upper limit of normal)

  • Imaging (CT, MR, ultrasound) criteria.

Systemic inflammatory response syndrome (SIRS) criteria with American College of Gastroenterology (ACG) guideline risk factors[9][65]

SIRS criteria are used for the grading of severity, not diagnosis, alongside evaluation of additional patient characteristics and risk factors.

Definition of SIRS met by the presence of at least two of the following criteria:[65]

  • Pulse >90 bpm

  • Respiratory rate >20 per minute or partial pressure of carbon dioxide (PaCO₂) <4.3 kPa

  • Temperature >38°C or <36°C

  • WBC count >12 x 10⁹/L or <4 x 10⁹/L, or >10% immature neutrophils (bands).

Additional patient characteristics and factors identified by ACG as indicating severe acute pancreatitis:[9]

Patient characteristics

  • Age >55 years

  • Obesity (body mass index >30 kg/m²)

  • Altered mental status

  • Comorbid disease

Laboratory findings

  • Urea >20 mg/dL

  • Rising urea

  • Hematocrit (HCT) >44%

  • Rising HCT

  • Elevated creatinine

Radiology findings

  • Pleural effusions

  • Pulmonary infiltrates

  • Multiple or extensive extrapancreatic collections

Revised Atlanta classification[2]

The revised classification of acute pancreatitis identifies an early and a late phase of the disease. Severity is classified as mild, moderate, or severe.[2] 

  • Mild acute pancreatitis: the most common form, has no organ failure or local or systemic complications, and usually resolves in the first week.

  • Moderately severe acute pancreatitis: presence of transient organ failure (resolves within 48 hours), and/or local complications or exacerbation of comorbid disease.

  • Severe acute pancreatitis: persistent organ failure (>48 hours). Local complications are common and include peri-pancreatic fluid collections, pancreatic and peri-pancreatic necrosis (sterile or infected), pseudocysts, and walled-off necrosis (sterile or infected).

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