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Development and Use of a New Staging System for Severe Acute Pancreatitis Based on a Nationwide Survey in Japan

Ogawa, Michio*†; Hirota, Masahiko*†; Hayakawa, Tetsuo; Matsuno, Seiki; Watanabe, Shinichiro; Atomi, Yutaka; Otsuki, Makoto; Kashima, Kei; Koizumi, Masaru; Harada, Hideo; Yamamoto, Masahiro; Nishimori, Isao


Methodology In 1997, a cooperative nationwide survey of 192 patients diagnosed with severe acute pancreatitis in 1996 was carried out.

Results Alcoholic pancreatitis was the major etiology (46%), and the male-to-female ratio was 2.6:1. Overall, the mortality rate was 27%, which was similar to the rate (30%) in the first nationwide survey of 1,219 patients diagnosed between 1982 and 1986 that was performed in 1987. A marked difference between the surveys was the early mortality rate within 2 weeks: 52% in the 1987 survey and 29% in the current survey. We devised a new stage classification system for acute pancreatitis. Stages 0 and 1 are equivalent to mild and moderate conditions, respectively, in the conventional classification, and stages 2 and higher correspond to severe acute pancreatitis. Severity scores of 2–8 are regarded as stage 2, scores of 9–14, as stage 3, and scores of ≥15, as stage 4. The mortality rates were as follows: 0, stages 0 and 1 at hospitalization; ≈10%, stage 2; ≈30–40%, stage 3; and ≈70–100%, stage 4.

Conclusion We found that stage at hospitalization reflected the prognosis of acute pancreatitis.

*Department of Surgery II, Kumamoto University Medical School, Kumamoto, and †Intractable Pancreatic Disease Investigation and Research Group of the Japanese Ministry of Health and Welfare, Kumamoto, Japan

Manuscript received November 30, 2000;

Revised manuscript accepted April 1, 2002.

Address correspondence and reprint requests to Dr. M. Ogawa, Department of Surgery II, Kumamoto University Medical School, 1–1-1 Honjo, Kumamoto-city, Kumamoto 860–0811, Japan.E-mail:

© 2002 Lippincott Williams & Wilkins, Inc.