Gastroenterology
Glasgow-Imrie Score (Pancreatitis)
Severity of acute pancreatitis (PANCREAS).
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Background
The Glasgow-Imrie score predicts severity in acute pancreatitis using eight routinely available results, usually assessed within the first 48 hours of admission. The criteria are summarised by the mnemonic PANCREAS: PaO₂ below 8 kPa, Age over 55, Neutrophils (white cell count above 15 ×10⁹/L), Calcium below 2 mmol/L, Renal (urea above 16 mmol/L), Enzymes (LDH above 600 U/L or AST above 200), Albumin below 32 g/L and Sugar (glucose above 10 mmol/L). Each present criterion scores one point, giving a maximum of eight. It was developed as a simpler alternative to the Ranson criteria.
Interpreting the result
A score of 0–2 predicts mild disease, whereas a score of 3 or more predicts severe acute pancreatitis with a higher risk of complications and death. A score of 3 or above should prompt consideration of high-dependency or intensive-care management and close monitoring for organ dysfunction. As with all severity scores, it complements rather than replaces clinical assessment and serial review. It is best applied at the 48-hour mark, by which time the relevant results have evolved.
Worked example
A 60-year-old admitted with acute pancreatitis has, at 48 hours, age over 55 (1), white cell count 18 ×10⁹/L (1), urea 18 mmol/L (1) and albumin 30 g/L (1), giving a Glasgow-Imrie score of 4. This predicts severe disease and should prompt consideration of higher-level care.
Pearls / pitfalls
- It is best assessed at 48 hours, since several criteria evolve over the first two days and an early score can under-call severity.
- It predicts severity, not aetiology, and does not by itself indicate the need for intervention such as drainage.
- A low score does not guarantee a benign course; clinical deterioration overrides a reassuring score.
- Modern practice increasingly combines or replaces it with markers such as CRP and organ-failure assessment.
Evidence & validation
Derived by Blamey, Imrie and colleagues and published in Gut in 1984 as a refinement of earlier prognostic systems; it is endorsed in UK guidance (including British Society of Gastroenterology recommendations) as one of the recognised early severity scores in acute pancreatitis.
Frequently asked questions
What Glasgow-Imrie score indicates severe pancreatitis?
A score of 3 or more predicts severe acute pancreatitis and should prompt consideration of high-dependency or intensive-care management. A score of 0–2 predicts mild disease.
When should the score be calculated?
It is best assessed within the first 48 hours, typically at the 48-hour point, because several of the criteria such as urea, calcium and albumin change over the first two days of the illness.
What does PANCREAS stand for?
It is a mnemonic for the eight criteria: PaO₂, Age, Neutrophils (white cells), Calcium, Renal (urea), Enzymes (LDH/AST), Albumin and Sugar (glucose). Each present criterion scores one point.
How does it differ from the Ranson criteria?
Glasgow-Imrie was designed as a simpler, single set of criteria applicable to all causes and assessable within 48 hours, whereas the Ranson system splits criteria between admission and 48 hours and was derived largely in alcohol-related disease.
Can a low score be falsely reassuring?
Yes. A patient with a low score can still deteriorate, so clinical judgement and serial monitoring take precedence over a single reassuring score.
References
- Blamey SL, Imrie CW, O'Neill J, et al. Prognostic factors in acute pancreatitis. Gut. 1984;25(12):1340–1346.
- Working Party of the British Society of Gastroenterology. UK guidelines for the management of acute pancreatitis. Gut. 2005.
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