Revised Marshall Score: A New Approach to Stratifying the Severity of Acute Pancreatitis

  • Yazan Abu OmarEmail author
  • Bashar M. Attar
  • Rohit Agrawal
  • Tejinder Randhawa
  • Muhammad Majeed
  • Yanting Wang
  • Carlos Roberto Simons-Linares
  • Yuchen Wang
Original Article



Modified Marshall Score is one of the severity scores for acute pancreatitis (AP) and is included in the Revised Atlanta Classification, but given its utilization of a set serum creatinine level (sCr), it may misclassify stable patients with chronic kidney disease (CKD) to a more severe class just due to their elevated sCr.


Our study aims to evaluate the role of CKD in AP and the possibility of utilizing acute kidney injury (AKI) into developing a new scoring system.


We retrospectively reviewed the electronic medical records of three hundred consecutive patients who were diagnosed with AP during hospitalization. Multiple demographic variables and clinical course indices were collected. Univariate logistic regression was then applied to predict mortality and ICU admission. Finally, receiver operating curve was utilized to compare original versus New Revised Marshall Score.


Two hundred and eight-four (284) patients had a definitive diagnosis of AP. When comparing patients who had AKI on admission to those without AKI, the AKI group showed statistically significant higher mortality rate (5.6% vs. 1.1%, p = 0.04). Finally, we substituted the renal part of Marshall Score with our AKIN and we plotted the New “Revised” Marshall Score, which showed a higher AUROC compared to the original modified version (C-statistics 0.93 vs. 0.89, p < 0.05).


We found that AKI predicts mortality and outperforms the use of a fixed sCr value alone. The use of our New Revised Marshall Score can accurately classify AP severity, avoiding misclassification of AP severity and providing better patient care.


Acute pancreatitis Acute kidney injury Marshall score Pancreas Pancreatic injury 


Author’s contribution

Yazan Abu Omar contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis. Bashar M. Attar was involved in study supervision. Rohit Agrawal helped in analysis and interpretation of data and obtained material support. Tejinder Randhawa, Muhammad Majeed and Yanting Wang contributed to drafting of the manuscript. Carlos Roberto Simons-Linares was involved in critical revision for important intellectual content. Yuchen Wang contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; material support; study supervision.

Compliance with Ethical Standards

Conflict of interest

The manuscript has not been published elsewhere and is not under consideration for publication. All authors declare no financial disclosure or competing interests and approve this submission.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineCook County Health and Hospital SystemChicagoUSA
  2. 2.Department of GastroenterologyRush University Medical CenterChicagoUSA
  3. 3.Division of Gastroenterology and Hepatology, Department of MedicineCook County Health and Hospital System, CountyChicagoUSA
  4. 4.Gastroenterology and Hepatology Department, Digestive Disease InstituteCleveland ClinicClevelandUSA

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