Interpretation
| Result | Meaning |
|---|---|
| All systems < 2 | No organ failure |
| Any system ≥ 2, < 48 h | Transient organ failure: moderately severe AP |
| Any system ≥ 2, > 48 h | Persistent organ failure: severe AP |
Formula
Respiratory P/F: >400 0, 301–400 1, 201–300 2, 101–200 3, ≤101 4 · Renal creatinine µmol/L: ≤134 0, 134–169 1, 170–310 2, 311–439 3, >439 4 · CV: SBP ≥90 0, <90 fluid-responsive 1, <90 not responsive 2, <90 & pH <7.3 3, <90 & pH <7.2 4
Clinical pearls
- Non-ventilated patients: estimate FiO₂ as room air 21%, 2 L/min 25%, 4 L/min 30%, 6–8 L/min 40%, 9–10 L/min 50%.
- In pre-existing CKD, grade renal failure by deterioration from baseline creatinine.
- Severity is decided by duration: repeat daily; one value cannot distinguish transient from persistent organ failure.
Examples
modified marshall pao2 75 fio2 30% creatinine 2.0 sbp normalmarshall score pancreatitis PaO2 60 on room air, cr 150 umol/L, SBP 85 not fluid responsive
FAQ
How is organ failure defined in acute pancreatitis?
A modified Marshall score of 2 or more in the respiratory, renal or cardiovascular system.
What is severe acute pancreatitis under revised Atlanta?
Organ failure that persists beyond 48 hours. Organ failure that resolves within 48 hours, or local complications without persistent failure, is moderately severe.