Assessing the efficacy of modified Marshall scoring system in severity assessment of acute pancreatitis in comparison to Ranson score at tertiary centre


  • Aakansha Vashistha Department of General Surgery, Sawai Mansingh Hospital, Jaipur, Rajasthan, India
  • Radha Govind Khandelwal Department of General Surgery, Sawai Mansingh Hospital, Jaipur, Rajasthan, India
  • Prabha Om Department of General Surgery, Sawai Mansingh Hospital, Jaipur, Rajasthan, India
  • Manish Rundla Department of General Surgery, Sawai Mansingh Hospital, Jaipur, Rajasthan, India



Modified Marshall score, Acute pancreatitis, Pancreatitis scoring system


Background: Early determination of severity of acute pancreatitis is essential for prediction of prognosis and proper treatment selection. This study aims to evaluate the effectiveness of the Modified Marshall scoring system in evaluating severity in acute pancreatitis at admission.

Methods: A hospital based prospective observational study was conducted at SMS medical college, Jaipur from May 2019 to September 2021 with a sample size of 60 patients. Modified Marshall Score and Ranson’s score were done at admission and 48 hours respectively for same patient.

Results: Most patients (31.66%) were among age group 31-45 years (mean age 43.95±16.28 years) with slight female (51.55%) preponderance. The mean hospital stay was 4.883±3.405 days with maximum mortality in first week (6/8). All patients with mild pancreatitis under Modified Marshall score were discharged uneventfully while patients with severe pancreatitis, 8 (25%) died. Respiratory system failure (48.33%) was most commonly involved followed by renal (16.66%) and cardiovascular system (11.66%). Single organ failure (35%) had no mortality while 2/3 patients with all three-organ system failure died. The AUC value of ROC curve (0.863) (p<0.001) showed that Modified Marshall score is a significant predictor for severity of acute pancreatitis. The correlation coefficient was strongly positive and statistically significant (p<0.001) for the relationship between Ranson’s score, Modified Marshall score and hospital stay.

Conclusions: Modified Marshall Score is simple and equally effective tool for predicting severity and prognosis early in the course of disease. Therefore, it prevents delay in aggressive treatment of critically ill patient and would contribute to decrease mortality.


Beger HG, Rau BM. Severe acute pancreatitis: Clinical course and management. World J Gastroenterol. 2007; 13(38):5043-51.

Bradley EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta. Arch Surg. 1993;128(5):586-90.

Mayumi T, Takada T, Kawarada Y, Hirata K, Yoshida M, Sekimoto M, et al. Management strategy for acute pancreatitis in the JPN Guidelines. J Hepatobiliary Pancreat Surg. 2006;13(1):61-7.

Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician. 2007;75(10):1513-20.

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Acute Pancreatitis. World J Gastroenterol. 2010;11(18):108-11.

Marshall JC, Cook DJ, Christou NV. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638-52.

Ranson JH, Rifkind KM, Roses DF. objective early identification of severe acute pancreatitis. Am J Gastroenterol. 1974;61:443-51.

Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101 101:2379-400.

Fagenholz PJ, Castillo CF, Harris NS. Increasing United States hospital admissions for acute pancreatitis, 1988-2003. Ann Epidermiol. 2007;17: 491-7.

UK Working Party. Acute Pancreatitis. Gut. 2005;54:1-9.

Kaushik MR, Dubey AP, Jain R, Rathore A, Pathak A. Prospective evaluation of the BISAP score and its correlation with Marshall score in predicting severity of organ failure in acute pancreatitis. Int J Adv Med. 2017;4:534-9.

Singh V. Pancreatitis. Am J Gastroenterol. 2009;104: 966-71.

Papachristou GI, Muddana V, Yadav D, O'Connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson's, APACHE-II and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010;105(2):435-41.

Lalithkumar J, Chitra T, Kodieswaran N. Comparative study between BISAP and Ranson’s score in predicting severity of acute pancreatitis. IAIM. 2016;3(9):23-33.

Carioca AL, Jozala DR, Bem LO, Rodrigues JMS. Severity assessment of acute pancreatitis: applying Marshall scoring system. Rev Col Bras Cir. 2015; 42(5):325-7.

Thandassery RB, Yadav TD, Dutta U. Dynamic nature of organ failure in severe acute pancreatitis: the impact of persistent and deteriorating organ failure. HPB. 2013;15:523-8.

Chatzicostas C, Roussomoustakaki M, Vlachonikolis IG, Notas G, Mouzas I, Samonakis D, et al. Comparison of Ranson, APACHE II and APACHE III scoring systems in acute pancreatitis. Pancreas. 2002; 25(4):331-5.

DeBernardinis M, Violi V, Roncoroni L, Boselli AS, Giunta A, Peracchia A. Discriminant power and information content of Ranson’s prognostic signs in acute pancreatitis: a meta-analytic study. Crit Care Med. 1999;27(10):2272-83.

Shiqi W, Xiangying F, Shujun L, Chaoxu L, Bin X, Bin B, et al. Utilizing multiparameter scores and procalcitonin as prognosis markers for the degree of severity of acute pancreatitis. Pancreas. 2003;15(2):38-42.

Arunkumar R. Comparitive Study Between Bisap Score And Ranson Score In Predicting Severity Of Acute Pancreatitis. Rev Col Bras Cir. 2011;12(3):23-8.

Giunta A, Peracchia A. Acute Pancreatitis Working Group. Revision of the Atlanta classification of acute pancreatitis. Int J Adv Med. 2008;1:62-8.

Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut. 2004;53(9):1340-4.

Campos T, Parreira JG, Assef JC, Rizoli S, Nascimento B, Fraga GP. Classificação de gravidade na pancreatite aguda. Rev Col Bras Cir. 2013;40(2):164-8.

Singh VK, Bollen TL, Wu BU. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol. 2011;9:1098-103.

Vege SS, Gardner TB, Chari ST. Low mortality and high morbidity in severe acute pancreatitis without organ failure: a case for revising the Atlanta classification to include moderately severe acute pancreatitis. Am J Gastroenterol. 2009;104:710-5.

Harrison S. Principles of internal medicine. 19th ed. In: Acute and Chronic Pancreatitis. USA: Greenberger publisher; 2010:2091-3.






Original Research Articles