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Kelly Meek, MD; Katayoun Toosie, MD; Bruce E. Stabile, MD; Magdi Elbassir, MD; Zuri Murrell, MD; Roger J. Lewis, MD, PhD; Lin Chang, MD; Christian de Virgilio, MD

Arch Surg. 2000;135:1048-1052.

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<.001), an APACHE II score of 5 or greater (P = .008), a modified Imrie score of 3 or greater (P<.001), and a biliary Ranson score of 3 or greater (P = .03) were statistically associated with the development of severe complications; whereas a blood urea nitrogen level of 4.3 mmol/L or more (≥12 mg/dL) and a heart rate of 100 beats per minute or more were not. On multivariate analysis, only a serum glucose level of 8.3 mmol/L or more (≥150 mg/dL) was predictive of adverse events (P<.001).

Conclusions  Glucose level (≥8.3 mmol/L [≥150 mg/dL]) is the best single admission predictor of severe complications of gallstone pancreatitis and is superior to an APACHE II score of 5 or greater, a modified Imrie score of 3 or greater, and a biliary Ranson score of 3 or greater.

From the Departments of Surgery (Drs Meek, Toosie, Stabile, Elbassir, Murrell, and de Virgilio) and Emergency Medicine (Dr Lewis), Harbor–UCLA Medical Center, Torrance, Calif; and the Department of Medicine, Division of Gastroenterology, UCLA Medical Center, Los Angeles, Calif (Dr Chang). The authors have no commercial, proprietary, or financial interests in the products or companies described in this article.

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