Can the time course of systemic inflammatory response syndrome score predict future organ failure in acute pancreatitis?

Objectives: In patients with acute pancreatitis (AP), we aimed to precisely quantify the association between systemic inflammatory response syndrome score (SIRSS), an easily measured bedside tool, and various adverse outcomes of AP.

Methods: We prospectively identified patients admitted to Mayo Clinic on day 1 of AP. Patients with positive SIRSS (S2) on day 1 were further followed up with daily measurement of SIRSS and organ failure status for 14 days or until discharge. Positive SIRSS on day 1, persistent SIRSS on day 3, and time course of SIRSS were correlated with development of organ failure.

Results: SIRSS and persistent SIRSS were associated with all the complications of AP with a high sensitivity and negative predictive value, ranging from 73.1% to 100.0%. Persistent SIRSS at day 3 added significantly higher specificity to this association (71.7%-80.0%). All patients who developed late-onset organ failure had the highest possible value of cumulative SIRSS.

Conclusions: SIRSS of less than 2 on day 1 has a high negative predictive value for complications of AP. Eighty percent of the patients with persistent SIRSS on day 3 will develop at least 1 adverse outcome. A new variable "cumulative SIRSS" has the potential to reliably predict late-onset persistent organ failure.