Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Koutroumpakis, Efstratios; Wu, Bechien U.; Bakker, Olaf J.; Dudekula, Anwar; Singh, Vikesh K.; Besselink, Marc G.; Yadav, Dhiraj; Santvoort, Hjalmar C. van; Whitcomb, David C.; Gooszen, Hein G.; Banks, Peter A.; Papachristou, Georgios I.

doi:10.1038/ajg.2015.370

Cited by 131 publications

(124 citation statements)

References 32 publications

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“…Average glucose levels differed significantly between the three AP severity groups. Although others have reported that a haematocrit value above 44% and a rise in BUN are associated with persistent organ failure [33], our results could not confirm these findings.…”

Section: Discussioncontrasting

confidence: 99%

Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis

et al. 2016

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ObjectiveThe aim of this study was to analyse the clinical characteristics of acute pancreatitis (AP) in a prospectively collected, large, multicentre cohort and to validate the major recommendations in the IAP/APA evidence-based guidelines for the management of AP.DesignEighty-six different clinical parameters were collected using an electronic clinical research form designed by the Hungarian Pancreatic Study Group.Patients600 adult patients diagnosed with AP were prospectively enrolled from 17 Hungarian centres over a two-year period from 1 January 2013.Main ResultsWith respect to aetiology, biliary and alcoholic pancreatitis represented the two most common forms of AP. The prevalence of biliary AP was higher in women, whereas alcoholic AP was more common in men. Hyperlipidaemia was a risk factor for severity, lack of serum enzyme elevation posed a risk for severe AP, and lack of abdominal pain at admission demonstrated a risk for mortality. Abdominal tenderness developed in all the patients with severe AP, while lack of abdominal tenderness was a favourable sign for mortality. Importantly, lung injury at admission was associated with mortality. With regard to laboratory parameters, white blood cell count and CRP were the two most sensitive indicators for severe AP. The most common local complication was peripancreatic fluid, whereas the most common distant organ failure in severe AP was lung injury. Deviation from the recommendations in the IAP/APA evidence-based guidelines on fluid replacement, enteral nutrition and timing of interventions increased severity and mortality.ConclusionsAnalysis of a large, nationwide, prospective cohort of AP cases allowed for the identification of important determinants of severity and mortality. Evidence-based guidelines should be observed rigorously to improve outcomes in AP.

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Section: Discussioncontrasting

confidence: 99%

Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis

et al. 2016

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“…As expected, our results indicated that patients with biliary etiology had a statistically significant 56% (OR: 0.44; 95% CI: 0.22–0.87) reduction in the odds of persistent organ failure compared to patients without biliary etiology. Simple, routine biomarkers such as hematocrit [7] and blood urea nitrogen (BUN) [7, 51–53] have been proposed as markers of disease severity. Koutroumpakis et al [7] suggested that admission hematocrit ≥ 44% and rise in BUN at 24 hrs may be the optimal predictive tools in clinical practice among existing laboratory parameters and scoring systems.…”

Section: Discussionmentioning

confidence: 99%

“…Simple, routine biomarkers such as hematocrit [7] and blood urea nitrogen (BUN) [7, 51–53] have been proposed as markers of disease severity. Koutroumpakis et al [7] suggested that admission hematocrit ≥ 44% and rise in BUN at 24 hrs may be the optimal predictive tools in clinical practice among existing laboratory parameters and scoring systems. Mounzer et al [2] showed that BUN had similar accuracy in comparison with more complex scoring systems in predicting organ failure.…”

Section: Discussionmentioning

confidence: 99%

“…Except for serum albumin level and the time from pain onset to admission [8], all other variables, namely, age (≥60 years) [8], male sex [27], BMI (≥30) [28], biliary etiology (yes versus no), chronic concomitant diseases (yes versus no) [12], hematocrit (≥44%) [7], total bilirubin (≥2 mg/dL), alanine aminotransferase (ALT > 50 units/L) [29], glucose (≥150 mg/dL) [28], and blood urea nitrogen (BUN) (>25 mg/dL) [5], were used as dichotomous/categorical variable when performing logistic regression analysis. Variables reaching statistical difference among patients with different albumin levels or between patients with and without organ failure in univariate logistic regression analysis were included in the multivariate logistic regression analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Existing scoring system such as the Bedside index of severity in acute pancreatitis (BISAP) [5] and the Harmless acute pancreatitis score (HAPS) [6] have moderate diagnostic accuracy in the prediction of persistent organ failure [2]. More recently, attention has also focused on assessing the association between persistent organ failure in acute pancreatitis and individual laboratory parameters such as admission hematocrit ≥ 44%, rise in blood urea nitrogen (BUN) at 24 hours [7], serum triglycerides [8], and high-density lipoprotein [9]. …”

Section: Introductionmentioning

confidence: 99%

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Serum Albumin Is Independently Associated with Persistent Organ Failure in Acute Pancreatitis

Hong

Lin

Zippi

et al. 2017

Canadian Journal of Gastroenterology and Hepatology

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Background and Aims To investigate the association between serum albumin levels within 24 hrs of patient admission and the development of persistent organ failure in acute pancreatitis. Methods A total of 700 patients with acute pancreatitis were enrolled. Multivariate logistic regression and subgroup analysis determined whether decreased albumin was independently associated with persistent organ failure and mortality. The diagnostic performance of serum albumin was evaluated by the area under Receiver Operating Characteristic (ROC) curves. Results As levels of serum albumin decrease, the risk of persistent organ failure significantly increases (Ptrend < 0.001). The incidence of organ failure was 3.5%, 10.6%, and 41.6% in patients with normal albumin and mild and severe hypoalbuminaemia, respectively. Decreased albumin levels were also proportionally associated with prolonged hospital stay (Ptrend < 0.001) and the risk of death (Ptrend < 0.001). Multivariate analysis suggested that biliary etiology, chronic concomitant diseases, hematocrit, blood urea nitrogen, and the serum albumin level were independently associated with persistent organ failure. Blood urea nitrogen and the serum albumin level were also independently associated with mortality. The area under ROC curves of albumin for predicting organ failure and mortality were 0.78 and 0.87, respectively. Conclusion A low serum albumin is independently associated with an increased risk of developing of persistent organ failure and death in acute pancreatitis. It may also be useful for the prediction of the severity of acute pancreatitis.

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Clinical Assessment and Biochemical Markers to Objectify Severity and Prognosis

Rau¹,

Alsfasser

2018

The Pancreas

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Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Cited by 131 publications

References 32 publications

Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis

Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis

Serum Albumin Is Independently Associated with Persistent Organ Failure in Acute Pancreatitis

Clinical Assessment and Biochemical Markers to Objectify Severity and Prognosis

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