ASSESSMENT OF SEVERITY OF ACUTE PANCREATITIS It is impoant to define that group of patients who will develop severe pancreatitis, as they are the ones with poorer outcomes and therefore they require aggressive early management and possibly transfer to a specialist unit. A severe attack may be heralded by an initial clinical impression of a very ill patient and a worsening physiological state at 24-48 hours. Various prognostic scoring systems have been used, all aimed at predicting persistent organ failure, paicularly respiratory, cardiac and renal. Severity stratification assessments should be performed in patients at 24 hours, 48 hours and 7 days after admission. The Ranson and Glasgow scoring systems are specific for acute pancreatitis, and a score of 3 or more at 48 hours indicates a severe attack. Several other systems that are used in intensive care units can also be applied. These include the APACHE, SAPS, SOFA, MODS and modified Marshall scoring systems (the latter has the advantage of simplicity). Regardless of the system used, persisting organ failure indicates a severe attack. A serum C-reactive protein level >150 mg/L at 48 hours after the onset of symptoms is also an indicator of severity. Patients with a body mass index over 30 are at higher risk of developing complications. A revision in 2013 of the Atlanta classification of acute pancreatitis (1992) recommends that patients with acute pancreatitis be stratified into 3 groups: Mild acute pancreatitis: * no organ failure; * no local or systemic complications. Moderately severe acute pancreatitis: * organ failure that resolves within 48 hours (transient organ failure); and/or * local or systemic complications without persistent organ failure. Severe acute pancreatitis: * persistent organ failure (>48 hours); * single organ failure; * multiple organ failure. Ref: Bailey and love 27th edition Pgno : 1224