Prognostic Evaluation of Acute Pancreatitis: When and How - Consequences for Clinical Management

The diagnosis of “acute pancreatitis” is established relatively rapidly and reliably by an exact case history, typical clinical symptoms during physical examination, and overall by specific laboratory tests, namely, serum pancreatic enzymes [1–8]. However, a clear differentiation of acute pancreatitis in acute interstitial edematous pancreatitis (clinically mild to moderate course) and necrotizing pancreatitis (clinically severe course, with high morbidity and mortality rates even today) is not possible by means of clinical symptoms and routine clinical laboratory parameters. In particular, serum pancreatic enzymes have been shown not to be able to discriminate between mild and severe courses of acute pancreatitis [1–8]. More recently, carboxylic ester hydrolase (CEH) and human pancreas-specific protein (hPASP) have been introduced as being significantly higher elevated in necrotizing pancreatitis as compared to edematous pancreatitis; however, further investigations are mandatory [9, 10].