Evaluation of Early Prognostic Factors of Mortality in Patients with Acute Pancreatitis: A Retrospective Study

Zhang, Wenzheng; Hu, Jiang; Yao, Bihui; Yang, Xvsheng; Song, Lei; Yin, Ting; Lü, Liang

doi:10.1155/2017/8363561

Cited by 16 publications

(18 citation statements)

References 25 publications

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“…Nevertheless, a close correlation between mortality and blood glucose, urea, partial pressure of oxygen, white blood cell count, hemoglobin, total bilirubin and cholesterol was shown in patients with AP, and these lab results serve as prognostic markers for predicting mortality. 9,10 Similar to our outcome findings, in a clinical trial, it was shown that aggressive resuscitation initiated within 4 hours of pancreatitis diagnosis hastened clinical improvement by reducing hemoconcentration and persistent SIRS development. 6 The proportion of patients with clinical improvement, as well as rate of improvement within 36 hours, was higher in the aggressive resuscitation group compared to the standard resuscitation group.…”

Section: Variablesupporting

confidence: 86%

Early Aggressive Hydration Is Associated with Decreased Opioid Use and Readmission in Mild Acute Pancreatitis

Doshi¹,

Liang²,

Toklu³

et al. 2020

HCA Healthcare Journal of Medicine

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Background Acute pancreatitis (AP) is one of the most common causes of hospital admissions due to gastrointestinal disorders. No pharmacologic agents have been proven to impact the prognosis, and the treatment still remains supportive with intravenous fluids for hydration. Although early hydration has been recommended for the management of mild AP, there is no consensus on the type, rate, and amount of the fluid replacement. Objective In this study, we aimed to investigate the outcome of aggressive hydration in patients with AP. Methods Retrospective data from patients admitted to 12 hospitals (2015-2017) was used for analysis. Five hundred patients who met the inclusion and exclusion criteria for mild AP were included. The subjects were classified into 3 groups based on the amount of intravenous fluids they received in the first 12 hours of admission: Hydration group A (0-1.5 ml/kg/h), Hydration group B (>1.5-3 ml/kg/h) and Hydration group C (>3 ml/kg/h). Laboratory test results on the second day of admission, length of stay (LOS) and opioid analgesic use on the last day were analyzed using a Chi-square test. A p-value of less than 0.05 was considered statistically significant. Results Patients with aggressive hydration (>3 ml/kg/h) had a greater reduction in creatinine (mean difference =-0.05, p = 0.017) compared to those who received standard hydration (0-1.5 ml/kg/h). There was no significant difference in LOS among the three hydration groups. Patients with aggressive hydration were less likely to use opioid analgesics on the last day of hospitalization (23.9% vs. 35.3%, p = 0.044) compared to standard hydration. Patients with hydration were less likely to experience a readmission for any reason within 30 days (Odds ratio (OR) = 1.603, 95% CI, 1.064-2.414, p = 0.024) compared to those who received low hydration. Conclusions Our findings showed that less narcotics were required for the patients receiving aggressive hydration in mild AP. On the other hand, early aggressive hydration is not widely implemented in community hospitals, despite beneficial effects.

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Section: Variablesupporting

confidence: 86%

Early Aggressive Hydration Is Associated with Decreased Opioid Use and Readmission in Mild Acute Pancreatitis

Doshi¹,

Liang²,

Toklu³

et al. 2020

HCA Healthcare Journal of Medicine

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“…On admission albumin levels were found to have poor predictive values for mortality and severity. Previous studies were mainly retrospective and had a much smaller sample size 5 , 19 , 20 . They only assessed the predictive value of serum albumin for persistent organ failure and peripancreatic infection, or were limited to severe AP.…”

Section: Discussionmentioning

confidence: 99%

“…Small retrospective cohort studies have shown that hypoalbuminemia is an independent risk factor for severe AP and in-hospital mortality in adults and children 5 , 6 . Serum albumin has been reported to be associated with persistent organ failure and prolonged hospital stay 7 .…”

Section: Introductionmentioning

confidence: 99%

Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality

Ocskay

Vinkó

Németh

et al. 2021

Sci Rep

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The incidence and medical costs of acute pancreatitis (AP) are on the rise, and severe cases still have a 30% mortality rate. We aimed to evaluate hypoalbuminemia as a risk factor and the prognostic value of human serum albumin in AP. Data from 2461 patients were extracted from the international, prospective, multicentre AP registry operated by the Hungarian Pancreatic Study Group. Data from patients with albumin measurement in the first 48 h (n = 1149) and anytime during hospitalization (n = 1272) were analysed. Multivariate binary logistic regression and Receiver Operator Characteristic curve analysis were used. The prevalence of hypoalbuminemia (< 35 g/L) was 19% on admission and 35.7% during hospitalization. Hypoalbuminemia dose-dependently increased the risk of severity, mortality, local complications and organ failure and is associated with longer hospital stay. The predictive value of hypoalbuminemia on admission was poor for severity and mortality. Severe hypoalbuminemia (< 25 g/L) represented an independent risk factor for severity (OR 48.761; CI 25.276–98.908) and mortality (OR 16.83; CI 8.32–35.13). Albumin loss during AP was strongly associated with severity (p < 0.001) and mortality (p = 0.002). Hypoalbuminemia represents an independent risk factor for severity and mortality in AP, and it shows a dose-dependent relationship with local complications, organ failure and length of stay.

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“…[2,5] However, the Ranson criteria can only be determined after 48 hours of inpatient observation, while the APACHE II scoring system uses a point score based upon initial values of 12 routine physiologic measurements and is very complex to use. [6] The BISAP predicts severity, organ failure and death in AP very well and is as good as APACHE II, [7] but it is also reported to have a suboptimal sensitivity for mortality as well as SAP. [8] Regrettably, universally adopted criteria does not exist owing to their more parameters, low sensitivity, and the complex for quick evaluation.…”

Section: Introductionmentioning

confidence: 99%

Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase

et al. 2019

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Severity stratification and prognostic prediction at early stage is crucial for reducing the rates of mortality of patients with acute pancreatitis (AP). We aim to investigate the predicting performance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red-cell distribution width (RDW) combined with severity scores (sequential organ failure assessment [SOFA], bed-side index for severity of AP [BISAP], Ranson criteria, and acute physiology and chronic health evaluation II [APACHE II]) for severe AP (SAP) and mortality. A total of 406 patients diagnosed with AP admitted in a tertiary teaching hospital were enrolled. Demographic information and clinical parameters were retrospectively collected and analyzed. NLR, PLR, RDW, blood urea nitrogen (BUN), and AP severity scores (SOFA, BISAP, Ranson, and APACHE II) were compared between different severity groups and the survival and death group. Receiver-operating characteristic (ROC) curves for SAP and 28-day mortality were calculated for each predictor using cut-off values. Area under the curve (AUC) analysis and logistic regression models were performed to compare the performance of laboratory biomarkers and severity scores. Our results showed that NLR, PLR, RDW, glucose, and BUN level of the SAP group were significantly increased compared to the mild acute pancreatitis (MAP) group on admission ( P < .001). The severity of AP increased as the NLR, SOFA, BISAP, and Ranson increased ( P < .01). The AUC values of NLR, PLR, RDW, BUN, SOFA, BISAP, Ranson, and APACHE II to predict SAP were 0.722, 0.621, 0.787, 0.677, 0.806, 0.841, 0.806, and 0.752, respectively, while their AUC values to predict 28-day mortality were 0.851, 0.693, 0.885, 0.765, 0.968, 0.929, 0.812, and 0.867, respectively. BISAP achieved the highest AUC, sensitivity and NPV in predicting SAP, while SOFA is the most superior in predicting mortality. The combination of BISAP + RDW achieved the highest AUC (0.872) in predicting SAP and the combination of SOFA + RDW achieved the highest AUC (0.976) in predicting mortality. RDW (OR = 1.739), SOFA (OR = 1.554), BISAP (OR = 2.145), and Ranson (OR = 1.434) were all independent risk factors for predicting SAP, while RDW (OR = 7.361) and hematocrit (OR = 0.329) were independent risk factors for predicting mortality by logistic regression model. NLR, PLR, RDW, and BUN indicated good predictive value for SAP and mortality, while RDW had the highest discriminatory capacity. RDW is a convenient and reliable indicator for prediction not only SAP, but also mortality.

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Evaluation of Early Prognostic Factors of Mortality in Patients with Acute Pancreatitis: A Retrospective Study

Cited by 16 publications

References 25 publications

Early Aggressive Hydration Is Associated with Decreased Opioid Use and Readmission in Mild Acute Pancreatitis

Early Aggressive Hydration Is Associated with Decreased Opioid Use and Readmission in Mild Acute Pancreatitis

Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality

Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase

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