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Three Part Question

In [patients with acute pancreatitis] can the [SIRS criteria][predict the severity of the acute pancreatitis]

Clinical Scenario

A 69 year old man presents to the emergency department with epigastric pain that radiates to the back. He has been vomiting and has a fever. You suspect acute pancreatitis and wish to predict disease severity in order to start appropriate treatment.

Search Strategy

Medline 1966-06/98 using the OVID interface.
([exp pancreatitis] AND [exp systemic inflammatory response syndrome OR SIRS.mp]) LIMIT to human AND English language AND yr="1990-current" AND "all adult (19 plus years)"

Search Outcome

250 papers found of which 3 were of use. 247 papers were discarded as either irrelevant or of insufficient quality for inclusion.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Kumar A et al 2014 USA	117 patients with negative SIRS on day of diagnosis of acute pancreatitis vs patients with positive SIRS on day of diagnosis.	Prospective Cohort Study	Positive SIRS at day 1	Patients with positive SIRS at day 1 had significantly higher prevalence of all adverse outcomes. Sensitivity for these were also high (73%-100%).	Single Centre
			Persistent SIRS at day 3	Patients with persistent SIRS at day 3 had significantly higher incidence of all adverse outcomes. Sensitivity for these remained high and specificity increased (71%-81%).
			Cumulative SIRS and organ failure	A new variable
Singh et al 2009 USA	252 patients with acute pancreatitis, either with negative SIRS on day 1 or positive SIRS on day 1.	Prospective Cohort Study	Positive SIRS on day 1	SIRS on day 1 predicted severe disease with high sensitivity (85%-100%). The absence of SIRS on day 1 was associated with a high negative predictive value (98%-100%).	Single Centre
			Persistent SIRS	Patients with persistent SIRS had an increased risk for severe disease.
Mofidi R et al 2006 UK	759 patients with acute pancreatitis; either with no SIRS on admission, SIRS at admission or persistent SIRS (>48h).	Prospective Cohort Study	Median cumulative Marshall Score	Was significantly higher in patients with persistent SIRS compared to in patients in whom SIRS resolved or in those with no SIRS.	Single Centre
			Mortality	Patients with persistent SIRS had higher mortality rates than those with transient or no SIRS. (25%, 8% and 0.7% respectively)

Comment(s)

There are 3 prospective cohort studies all demonstrating SIRS as a good severity predicting score in acute pancreatitis.

Editor Comment

KdW

Clinical Bottom Line

SIRS can be used to predict severity in acute pancreatitis.

References

1. Kumar, Akshat MD*+; Chari, Suresh T. MD+; Vege, Santhi Swaroop MD+ Can the Time Course of Systemic Inflammatory Response Syndrome Score Predict Future Organ Failure in Acute Pancreatitis? Pancreas - LWW Journals October 2014; p 1101-1105
2. Singh VK; Wu BU; Bollen TL; Repas K; Maurer R; Mortele KJ; Banks PA Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clinical Gastroenterology & Hepatology Nov 2009; p 1247-1251
3. Mofidi R; Duff MD; Wigmore SJ; Madhavan KK; Garden OJ; Parks RW Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. The British journal of surgery Jun 2006; p 738-744