A Reproducible Admission Biochemical-Coagulation Scoring Protocol for Multiple Organ Dysfunction Syndrome in Acute Pancreatitis

Early recognition of multiple organ dysfunction syndrome in acute pancreatitis remains difficult because organ deterioration may occur before conventional severity assessments are complete. This article describes a reproducible protocol for developing, validating, and applying an admission biochemical-coagulation composite score based on routine laboratory tests obtained within 24 h of hospital admission. Multiple organ dysfunction syndrome was selected as the primary endpoint because it reflects clinically consequential dysfunction across more than one organ system and directly informs early monitoring intensity, escalation planning, and critical care resource allocation. The protocol covers multicenter cohort assembly, eligibility screening, endpoint adjudication, laboratory unit harmonization, missing-data processing, predictor scaling, penalized regression model development, hold-out validation, score construction, benchmarking against established severity scores, and sensitivity analyses. Continuous laboratory variables are retained during model development to reduce information loss, whereas clinically interpretable categories are used only when translating the final model into a practical bedside score. Procedural checkpoints include confirmation of cohort assembly, missingness thresholds, locked preprocessing rules, model-selection outputs, validation outputs, and final score interpretation. Using this workflow, routinely measured biochemical and coagulation markers can be integrated into a structured admission risk-stratification tool for acute pancreatitis-associated multiple organ dysfunction syndrome. The score is intended to support closer observation, repeated laboratory assessment, and preparation for organ-support pathways, but it should complement rather than replace clinical judgment or established severity frameworks.