Skip to main content

Advertisement

SpringerLink
Log in

Revised Marshall Score: A New Approach to Stratifying the Severity of Acute Pancreatitis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Background

Modified Marshall Score is one of the severity scores for acute pancreatitis (AP) and is included in the Revised Atlanta Classification, but given its utilization of a set serum creatinine level (sCr), it may misclassify stable patients with chronic kidney disease (CKD) to a more severe class just due to their elevated sCr.

Aims

Our study aims to evaluate the role of CKD in AP and the possibility of utilizing acute kidney injury (AKI) into developing a new scoring system.

Methods

We retrospectively reviewed the electronic medical records of three hundred consecutive patients who were diagnosed with AP during hospitalization. Multiple demographic variables and clinical course indices were collected. Univariate logistic regression was then applied to predict mortality and ICU admission. Finally, receiver operating curve was utilized to compare original versus New Revised Marshall Score.

Results

Two hundred and eight-four (284) patients had a definitive diagnosis of AP. When comparing patients who had AKI on admission to those without AKI, the AKI group showed statistically significant higher mortality rate (5.6% vs. 1.1%, p = 0.04). Finally, we substituted the renal part of Marshall Score with our AKIN and we plotted the New “Revised” Marshall Score, which showed a higher AUROC compared to the original modified version (C-statistics 0.93 vs. 0.89, p < 0.05).

Conclusion

We found that AKI predicts mortality and outperforms the use of a fixed sCr value alone. The use of our New Revised Marshall Score can accurately classify AP severity, avoiding misclassification of AP severity and providing better patient care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143:1179–1187. https://doi.org/10.1053/j.gastro.2012.08.002.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Toouli J, Brooke-Smith M, Bassi C, et al. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol. 2002;17:S15–S39.

    Article  Google Scholar 

  3. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111. https://doi.org/10.1136/gutjnl-2012-302779.

    Article  PubMed  Google Scholar 

  4. Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108:1400. https://doi.org/10.1038/ajg.2013.218.

    Article  CAS  PubMed  Google Scholar 

  5. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41. https://doi.org/10.1159/000180580.

    Article  CAS  PubMed  Google Scholar 

  6. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–1652.

    Article  CAS  Google Scholar 

  7. Halonen KI, Pettila V, Leppaniemi AK, Kemppainen EA, Puolakkainen PA, Haapiainen RK. Multiple organ dysfunction associated with severe acute pancreatitis. Crit Care Med. 2002;30:1274–1279.

    Article  Google Scholar 

  8. Vincent JL, Moreno R, Takala J, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–710.

    Article  CAS  Google Scholar 

  9. UK guidelines for the management of acute pancreatitis. Gut. 2005;54 Suppl 3:iii1-9. https://doi.org/10.1136/gut.2004.057026

  10. Owyang C, Miller LJ, DiMagno EP, Mitchell JC 3rd, Go VL. Pancreatic exocrine function in severe human chronic renal failure. Gut. 1982;23:357–361.

    Article  CAS  Google Scholar 

  11. Quraishi ER, Goel S, Gupta M, Catanzaro A, Zasuwa G, Divine G. Acute pancreatitis in patients on chronic peritoneal dialysis: an increased risk? Am J Gastroenterol. 2005;100:2288–2293. https://doi.org/10.1111/j.1572-0241.2005.41646.x.

    Article  PubMed  Google Scholar 

  12. Banks PA. Epidemiology, natural history, and predictors of disease outcome in acute and chronic pancreatitis. Gastrointest Endosc. 2002;56:S226–S230. https://doi.org/10.1067/mge.2002.129022.

    Article  PubMed  Google Scholar 

  13. Lankisch PG, Weber-Dany B, Maisonneuve P, Lowenfels AB. Frequency and severity of acute pancreatitis in chronic dialysis patients. Nephrol Dial Transplant. 2008;23:1401–1405. https://doi.org/10.1093/ndt/gfm769.

    Article  PubMed  Google Scholar 

  14. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31. https://doi.org/10.1186/cc5713.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int. 1985;28:830–838.

    Article  CAS  Google Scholar 

  16. Moran SM, Myers BD. Course of acute renal failure studied by a model of creatinine kinetics. Kidney Int. 1985;27:928–937.

    Article  CAS  Google Scholar 

  17. Chen S. Retooling the creatinine clearance equation to estimate kinetic GFR when the plasma creatinine is changing acutely. J Am Soc Nephrol. 2013;24:877–888. https://doi.org/10.1681/ASN.2012070653.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Cook County Health and Hospital System, Chicago, IL, USA

    Yazan Abu Omar, Rohit Agrawal, Tejinder Randhawa, Muhammad Majeed, Yanting Wang & Yuchen Wang

  2. Department of Gastroenterology, Rush University Medical Center, Chicago, IL, USA

    Bashar M. Attar

  3. Division of Gastroenterology and Hepatology, Department of Medicine, Cook County Health and Hospital System, County, Chicago, IL, USA

    Bashar M. Attar

  4. Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA

    Carlos Roberto Simons-Linares

Authors
  1. Yazan Abu Omar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bashar M. Attar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rohit Agrawal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tejinder Randhawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Muhammad Majeed
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yanting Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carlos Roberto Simons-Linares
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuchen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Yazan Abu Omar contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis. Bashar M. Attar was involved in study supervision. Rohit Agrawal helped in analysis and interpretation of data and obtained material support. Tejinder Randhawa, Muhammad Majeed and Yanting Wang contributed to drafting of the manuscript. Carlos Roberto Simons-Linares was involved in critical revision for important intellectual content. Yuchen Wang contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; material support; study supervision.

Corresponding author

Correspondence to Yazan Abu Omar.

Ethics declarations

Conflict of interest

The manuscript has not been published elsewhere and is not under consideration for publication. All authors declare no financial disclosure or competing interests and approve this submission.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abu Omar, Y., Attar, B.M., Agrawal, R. et al. Revised Marshall Score: A New Approach to Stratifying the Severity of Acute Pancreatitis. Dig Dis Sci 64, 3610–3615 (2019). https://doi.org/10.1007/s10620-019-05719-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-019-05719-y

Keywords

Search

Navigation