The majority of patients (around 80%) with acute pancreatitis have mild disease and will improve within 3 to 7 days of conservative management. The overall mortality rate is low (approximately 5%) but this rises to 25% to 30% in severe acute pancreatitis.[8]National Institute for Health and Care Excellence. Pancreatitis. Dec 2020 [internet publication].
https://www.nice.org.uk/guidance/ng104
[56]Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014 Aug 12;349:g4859.
http://www.ncbi.nlm.nih.gov/pubmed/25116169?tool=bestpractice.com
The cause of pancreatitis should be identified, and a plan to prevent recurrence should be initiated before the patient is discharged from hospital.
Long-term prognosis is based on the aetiology and patient adherence to lifestyle modifications. Acute pancreatitis generally resolves and leaves pancreatic function intact. In some patients, acute pancreatitis can become recurrent acute pancreatitis, often leading to chronic pancreatitis. More than one fifth of patients with acute pancreatitis experience recurrence after discharge.[189]Li S, Gao L, Gong H, et al. Recurrence rates and risk factors for recurrence after first episode of acute pancreatitis: a systematic review and meta-analysis. Eur J Intern Med. 2023 Oct;116:72-81.
http://www.ncbi.nlm.nih.gov/pubmed/37330318?tool=bestpractice.com
The risk is higher among people who smoke, people with alcohol use disorder, and men.[190]Sankaran SJ, Xiao AY, Wu LM, et al. Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology. 2015 Nov;149(6):1490-500.
http://www.gastrojournal.org/article/S0016-5085(15)01175-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/26299411?tool=bestpractice.com
Overall, episodes of acute pancreatitis associated with chronic pancreatitis are associated with lower mortality than episodes of acute pancreatitis without chronic pancreatitis.[191]Bouça-Machado T, Bouwense SAW, Brand M, et al. Position statement on the definition, incidence, diagnosis and outcome of acute on chronic pancreatitis. Pancreatology. 2023 Mar;23(2):143-50.
https://www.sciencedirect.com/science/article/pii/S1424390323000352
http://www.ncbi.nlm.nih.gov/pubmed/36746714?tool=bestpractice.com
Scoring tools such as APACHE II, Ranson, or Glasgow are in widespread use but add limited value.[56]Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014 Aug 12;349:g4859.
http://www.ncbi.nlm.nih.gov/pubmed/25116169?tool=bestpractice.com
[57]Larvin M. Assessment of severity and prognosis in acute pancreatitis. Eur J Gastroenterol Hepatol. 1997 Feb;9(2):122-30.
http://www.ncbi.nlm.nih.gov/pubmed/9058621?tool=bestpractice.com
[58]Tenner S. Initial management of acute pancreatitis: critical issues during the first 72 hours. Am J Gastroenterol. 2004 Dec;99(12):2489-94.
http://www.ncbi.nlm.nih.gov/pubmed/15571599?tool=bestpractice.com
[59]Papachristou GI, Muddana V, Yadav D, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010 Feb;105(2):435-41.
http://www.ncbi.nlm.nih.gov/pubmed/19861954?tool=bestpractice.com
[60]Capurso G, Ponz de Leon Pisani R, Lauri G, et al. Clinical usefulness of scoring systems to predict severe acute pancreatitis: a systematic review and meta-analysis with pre and post-test probability assessment. United European Gastroenterol J. 2023 Nov;11(9):825-36.
https://onlinelibrary.wiley.com/doi/10.1002/ueg2.12464
http://www.ncbi.nlm.nih.gov/pubmed/37755341?tool=bestpractice.com
Their use is not recommended by evidence-based guidelines.[9]Tenner S, Vege S, Sheth S, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2024 Mar 119(3):419-37.
https://journals.lww.com/ajg/fulltext/2024/03000/american_college_of_gastroenterology_guidelines_.14.aspx
http://www.ncbi.nlm.nih.gov/pubmed/38857482?tool=bestpractice.com
[54]Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013 Jul-Aug;13(4 suppl 2):e1-15.
http://www.ncbi.nlm.nih.gov/pubmed/24054878?tool=bestpractice.com
[
APACHE II scoring system
Opens in new window
]
[
Pancreatitis Prognosis Criteria
Opens in new window
]