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Modified Glasgow Score

Imrie Criteria — Acute Pancreatitis Severity at 48 Hours

An 8-parameter severity scoring system assessed at 48 hours after admission for acute pancreatitis. Score ≥3 defines severe acute pancreatitis by UK guidelines (BSG/IAP).

General Surgery Pancreatitis HDU/ICU
Modified Glasgow (Imrie) Score — Assessed at 48h

All criteria assessed at 48 hours after admission

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Score / 8
Tick criteria above and calculate
Score ≥3 = Severe (BSG criteria)

Score Interpretation

Score Severity Mortality Setting
0–2 Mild <1% Ward
3–4 Moderate-Severe ~20% HDU/ICU consideration
≥5 Severe >40% ICU mandatory

PANCREAS Mnemonic

P PaO₂ <60 mmHg
A Age >55 years
N Neutrophils WBC >15 ×10⁹/L
C Calcium <2.0 mmol/L (corrected)
R Renal Urea >16 mmol/L
E Enzymes LDH >600 IU/L
A Albumin <32 g/L
S Sugar Glucose >10 mmol/L in non-diabetics

Clinical Application

  • Mnemonic PANCREAS: PaO₂, Age, Neutrophils (WBC), Calcium, Renal (Urea), Enzymes (LDH), Albumin, Sugar (Glucose)
  • Assessed at 48h: earlier assessment is unreliable as inflammation evolves; compare with BISAP (24h) and HAPS (admission)
  • Score ≥3 meets UK (BSG) definition of severe acute pancreatitis
  • HDU/ICU transfer recommended for scores ≥3 to allow fluid resuscitation monitoring
  • For scores ≥5: early enteral nutrition via nasojejunal tube preferred; early CECT may be deferred 72–96h to allow fluid sequestration to declare
  • Gallstone pancreatitis: early ERCP (within 72h) if cholangitis or CBD obstruction
  • Compare with BISAP Score (assessed at 24h) and Modified CTSI (imaging-based)

References

  1. Blamey SL, et al. Prognostic factors in acute pancreatitis. Gut. 1984;25(12):1340–1346.
  2. Imrie CW. Observations on acute pancreatitis. Br J Surg. 1974;61(7):539–544.
  3. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013.

Related Calculators

BISAP Score HAPS Score ISGPS Fistula Risk