The use of the peripheral leukocyte count and chest X-rays in early assessment of the severity of acute pancreatitis in comparison with the Ranson score system.

BACKGROUND

To evaluate the efficacy of the peripheral leukocyte count and chest X-rays as an index which could be used in the early assessment of the severity of acute pancreatitis in an Emergency Room.

METHODS

We prospectively evaluated the peripheral leukocyte count and the findings of chest X-rays in 181 consecutive patients (102 males, 79 females, mean age 61 years, range 16-97) who were admitted to our Emergency Department with acute pancreatitis. One hundred twenty six patients had mild pancreatitis and 55 had severe pancreatitis. The peripheral leukocyte count and the chest X-rays were evaluated in all patients upon admission. The Ranson criteria were also assessed.

RESULTS

Using a cut off value of 13,000/mm3, 45% of the patients with severe pancreatitis and 17% of those with mild acute pancreatitis had a peripheral leukocyte count greater than 13,000/mm3. Pleural or pulmonary alterations observed on chest X-ray were found in 66% of patients with severe pancreatitis and in 2% of those with mild acute pancreatitis. A peripheral leukocyte count greater than 13,000/mm3 and/or pleural or pulmonary alterations present on chest X-ray were found in 78% of the patients with severe pancreatitis and in 19% of those with mild pancreatitis. The Ranson criteria greater than or equal to three were found in 45% of the patients with severe acute pancreatitis and in 16% of those with the mild form of the disease. The positive predictive value was 92% for the presence of alterations on the chest X-rays, 64% for the alteration of at least one of the abnormal findings on the chest X-ray and a peripheral leukocyte count greater than 13,000/mm3, 56% for a peripheral leukocyte count greater than 13,000/mm3, and 54% for the presence of Ranson criteria greater than or equal to three. The negative predictive values were similar.

CONCLUSIONS

The presence of pleural or pulmonary alterations on chest X-rays may be useful in the Emergency Room for the early identification of patients with severe acute pancreatitis.