Table 3 Recommendations for the diagnosis of acute pancreatitis in the included guidelines (2014–2020)
From: Appraisal of the diagnostic procedures of acute pancreatitis in the guidelines
Guideline | Reference Standard | Ar [2] | Li [3] | Jo [4] | Ma [5] | AI [6] | GS [7] | PD [8] |
|---|---|---|---|---|---|---|---|---|
(1) Primary diagnosis of AP | ||||||||
Symptoms and signs | Abdominal pain (acute onset of a persistent, severe, epigastric pain often radiating to the back) | ● | ● | – | – | – | ● | ● |
Biochemical evidence | Serum lipase activity (or amylase) at least 3 times greater than the upper limit of normal | ● | ● | ● | ● | – | ● | ● |
Urinary trypsinogen-2 dipstick | О | |||||||
Characteristic findings from abdominal imaging | Characteristic findings of acute pancreatitis on ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI) | ● | ● | ● | ● | – | ● | ● |
(2) Classification of the severity of AP | ||||||||
Classification tools | Revised Atlanta Classification | ● | ● | ● | – | – | ● | ● |
Determinant-based Classification | ● | – | – | – | – | – | – | |
JPN Severity Score | – | – | – | ● | – | ● | – | |
Prognostic factors | C-reactive protein (CRP) level ≥ 150 mg/l | ● | ● | ● | – | – | – | ● |
Urea > 20 mg/dl | ● | – | – | – | – | ● | ● | |
CT Severity Index | ● | ● | – | – | – | – | – | |
Bedside index of severity of acute pancreatitis (BISAP) score | ● | – | – | ● | – | – | ● | |
Acute Physiology and Chronic Health Evaluation II (APACHE-II) score | ● | ● | ● | – | – | ● | ● | |
(3) Etiological diagnosis of AP | ||||||||
Ultrasound (US) / endoscopic ultrasound (EUS) | ● | ● | ● | ● | ● | ● | ● | |
Contrast-enhanced computed tomography (CECT) | ● | – | – | ● | – | – | – | |
Magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) | ● | ● | ● | ● | ● | – | ● | |
Endoscopic retrograde cholangiopancreatography (ERCP) | ● | ● | ● | ● | – | – | ● | |
Serum triglyceride levels ≥11.3mmol/L | ● | – | – | – | – | ● | ● | |
Genetic testing | – | – | – | – | – | ● | – | |
(4) Diagnosis of comorbidities of AP | ||||||||
CECT | ● | ● | ● | ● | ● | ● | ● | |
contrast-enhanced MRI | – | – | – | – | ● | ● | – | |
US | – | ● | – | – | – | – | – | |
Pancreatic necrosis/abdominal fluid collection/pseudocyst / walled-off necrosis (WoN) | Fine needle aspiration (FNA) | ● | ● | ● | ● | ● | ● | ● |
Infected collection, necrosis or WoN | MRCP | – | – | – | – | ● | – | – |
pancreatic fistula | sustained intra-abdominal pressure (IAP) > 20 mmHg | – | ● | – | ● | ● | – | ● |
Abdominal compartment syndrome (ACS) | CECT | – | – | ● | ● | ● | – | – |
Vascular complications | Hematocrit > 44% | ● | – | – | – | – | ● | ● |
Risk factors of pancreatic necrosis | Procalcitonin | ● | ● | – | – | – | – | ● |
Calcium levels | ● | – | – | – | – | – | ● | |