Table 1.
Japanese severity scoring system for acute pancreatitis of the Ministry of Health, Labour and Welfare of Japan (2008 revision) a
| Scoring system | Basis for score |
|---|---|
| Prognostic factor score (one point for each factor) |
|
| 1 |
Base excess less than or equal to -3 mEq/L or shock (systolic blood pressure below 80 mmHg) |
| 2 |
PaO2 ≤60 mmHg (room air) or respiratory failure (respiratory assistance needed) |
| 3 |
BUN ≥40 mg/dl or (or creatinine ≥2.0 mg/dl) or oliguria (daily urine output <400 ml even after intravenous fluid resuscitation) |
| 4 |
LDH at or above twice the upper limit of normal |
| 5 |
Platelet count ≤100,000/mm3 |
| 6 |
Serum calcium ≤7.5 mg/dl |
| 7 |
CRP ≥15 mg/dl |
| 8 |
Number of positive measures in SIRS criteria ≥3 |
| 9 |
Age ≥70 years |
| CT grade based on contrast-enhanced CT |
|
| 1 |
Extrapancreatic progression of inflammation |
| |
Anterior pararenal space, zero points |
| |
Root of mesocolon, one point |
| |
Beyond lower pole of kidney, two points |
| 2 |
Hypoenhanced lesion of the pancreas |
| |
Pancreas conveniently divided into three segments (head, body and tail). |
| |
Localized in each segment or surrounding only the pancreas, zero points |
| |
Extends to two segments, one point |
| |
Occupies two whole segments or more, two points |
| |
Factors 1 + 2 = total score |
| |
Total score = 0 or 1, grade 1 |
| |
Total score = 2, grade 2 |
| |
Total score = 3 or more, grade 3 |
| Assessment of severity | If prognostic factor score is ≥3 or CT grade is ≥2, acute pancreatitis is considered severe. |
aBUN, Blood urea nitrogen; CRP, C-reactive protein; CT, Computed tomography; LDH, Lactate dehydrogenase; PaO2, partial pressure of oxygen in blood; SIRS, Systemic inflammatory response syndrome. Measures within the SIRS criteria include body temperature above 38°C or less than 36°C, heart rate more than 90 beats/min, respiratory rate more than 20 breaths/min or partial pressure of carbon dioxide in blood less than 32 torr, as well as white blood cell count above 12,000 cells/mm3, less than 4,000 cells/mm3 or greater than 10% immature (band) forms. The 2008 revision of the Japanese severity scoring system is contained in [22].