This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
The modified Marshall score rates the failure of three organ systems from 0 to 4. John Marshall described the original multiple organ dysfunction score in 1995; the shortened version was adopted by the revised Atlanta classification of acute pancreatitis (Banks and colleagues, 2012) because it is simple, works at the bedside and can be repeated every day.
The three systems
| Score | Respiratory (PaO2/FiO2) | Renal (creatinine) | Cardiovascular (systolic pressure) |
|---|---|---|---|
| 0 | over 400 | under 1.4 mg/dL (134 µmol/L) | over 90 mmHg |
| 1 | 301 to 400 | 1.4 to 1.8 mg/dL | under 90, responds to fluids |
| 2 | 201 to 300 | 1.9 to 3.6 mg/dL | under 90, does not respond to fluids |
| 3 | 101 to 200 | 3.6 to 4.9 mg/dL | under 90 with pH under 7.3 |
| 4 | 101 or less | over 4.9 mg/dL | under 90 with pH under 7.2 |
Blood pressure is scored off inotropes. For patients with known chronic kidney disease, the renal score refers to the worsening from their usual creatinine.
When there is no arterial blood gas, the Atlanta authors suggest estimating FiO2 from the oxygen given: about 21% on room air, 25% at 2 L/min, 30% at 4 L/min, 40% at 6 to 8 L/min and 50% at 9 to 10 L/min.
Organ failure
A score of 2 or more in any one system defines organ failure. The calculator shows the total out of 12 and, more usefully, the number of failing systems.
Severity of acute pancreatitis (revised Atlanta)
- Mild: no organ failure and no local or systemic complications.
- Moderately severe: transient organ failure that resolves within 48 hours, or local complications such as fluid collections or necrosis, or worsening of a chronic disease.
- Severe: persistent organ failure lasting more than 48 hours, in one or several systems.
Because the 48-hour distinction is the key, the score should be repeated at least daily during the first days. A single score at admission cannot tell transient from persistent failure.
Example
A patient with PaO2/FiO2 of 260 (2 points), creatinine 1.1 mg/dL (0) and normal pressure (0) has a total of 2 and one failing system. If the respiratory failure is still present after 48 hours, the pancreatitis is classed as severe.
Limits
The score describes organ function, not the cause. Other markers, such as BISAP, Ranson or the CT severity index, look at different aspects of pancreatitis, and none replaces regular clinical review in a unit able to escalate care.