MSFinals-6106

MSFinals-6106

A 44-year-old man with alcohol dependence presents to the emergency department with sudden onset epigastric pain. The pain is severe and radiates to his back. He admits to drinking two bottles of vodka the night before. His vital signs are stable, with a heart rate of 72/min, respiratory rate of 16/min, blood pressure of 128/70 mmHg, and temperature of 38.2 ºC. Laboratory results show:

Hemoglobin: 130 g/L (Male: 135-180, Female: 115-160)
Platelets: 280 * 109/L (150-400)
White blood cells: 5.8 * 109/L (4.0-11.0)
Bilirubin: 18 µmol/L (3-17)
Alkaline phosphatase: 80 u/L (30-100)
Alanine transaminase: 42 u/L (3-40)
Gamma-glutamyl transferase: 60 u/L (8-60)
Albumin: 38 g/L (35-50)
Calcium: 1.8 mmol/L (2.1-2.6)
Amylase: 1200 U/L (70-300)

Based on the likely diagnosis, which of the following factors is a predictor of poor prognosis for this patient?