Baseline Hypoxemia as a Prognostic Marker for Pulmonary Complications and Outcome in Patients with Acute Pancreatitis

Abstract

The purpose of the present study was to investigate the prognostic role of severe hypoxemia on admission as an independent risk factor of pulmonary complications and mortality in patients with acute pancreatitis. Pulmonary complications were studied in 166 previously healthy patients with acute pancreatitis. Forty-eight patients (28.9%) developed one or more pulmonary complications, including pleural effusion, atelectasis, pulmonary consolidations, and acute respiratory distress syndrome (ARDS). Pulmonary consolidations (odds ratio = 7.25) and, especially, ARDS (odds ratio = 22.9) were significantly associated with severe baseline hypoxemia (PaO2, <60 mm Hg). Mortality was mainly related to severity of disease (odds ratio = 46.45), while hypoxemia was also found to be an independent risk factor of poor outcome (odds ratio = 9.56). It seems that, in patients with acute pancreatitis, severe hypoxemia on admission may be an early predictive marker of pulmonary complications, especially ARDS, and, independently of severity score, it may also be a marker of poor outcome.

Practice Guidelines in Acute Pancreatitis

“…In many (50, 55, 60, 67, 70, 75, 83, 86-88, 91, 128) but not all (31,46,53,61,165,168) reports, older age (generally ≥55 yr of age) has correlated with a more severe prognosis.…”

“…Several reports have pointed out that patients with organ failure at admission have a higher mortality than those who do not experience organ failure at admission (50,61,69,71,72,83,163). The progression of single organ failure to multisystem organ failure is a major determinant in the high mortality associated with organ failure at admission (83).…”

“…Furthermore, etiology has also been shown to have no prognostic significance (46,53,60,61,75,83,87,91,168) other than one report that indicated that patients with alcoholic pancreatitis in their first episode of pancreatitis have a greater need for intubation and greater prevalence of pancreatic necrosis (74).…”

“…It has already been noted that patients with organ failure at admission have a higher mortality than those who do not have organ failure at admission (50,61,69,71,72,83,163). It has also been determined that for patients who develop organ failure for the first time after admission, mortality may be as high when organ failure is experienced at admission (71,72,83,163).…”

Clinical outcomes in patients with ICU-related pancreatitis

“…Patients with severe pancreatitis are frequently associated with acute respiratory failure that subsequently develops into ARDS [12,13] . The development of ARDS is associated with a high mortality and is highly correlated with hypoxemic status [14] . Acute lung injur y and respirator y failure are frequent and potentially fatal complications of acute pancreatitis [15,16] .…”