Factors Predicting Mortality in Severe Acute Pancreatitis

Background: This study was designed to determine the most important early CT parameters predictive of acute pancreatitis severity. Methods: Three hundred and seventy-one consecutive patients with acute abdominal pain and hyperamylasemia were enrolled. Three hundred and ten of the 371 patients met our inclusion criteria. Acute pancreatitis severity was evaluated using the 1992 Atlanta criteria. Different CT parameters were reported from the admission abdominal CT by two radiologists blinded from any clinical parameter, but the patientsÕ age and gender. These variables were fitted in a binary logistic regression model. Results: Acute pancreatitis was mild in 80% cases, severe in 20% cases and lethal in 12.69% cases. The following CT parameters were significantly associated with the severity of acute pancreatitis: the objective size of the pancreas (P = 0.001), the peripancreatic fat abnormalities (P = 0.001) and the extent of necrosis (P = 0.007). Moreover, the age of the patient revealed itself a highly significant (P = 0.001) indicator of disease severity. The association of the four CT criteria eventually showed a sensitivity of 73% and a specificity of 81% to predict acute pancreatitis severity. Conclusion: Although these criteria correlated with disease severity, our study identified that morphological CT criteria cannot be used to triage patients with severe and mild acute pancreatitis.

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“…Our study confirmed prior results that age proved relevant to determine the severity of acute pancreatitis [8][9][10][11][12].…”

Section: Discussionsupporting

confidence: 92%

Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?

et al. 2006

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“…Although older literature suggested that 80% of deaths occur after several weeks of illness as a result of infected necrosis, more recent surveys have shown considerable variation with several reports showing a reasonably even distribution of early deaths (within 1-2 wk) versus later deaths (46,72,76,150,151,163), a few showing the majority of deaths within the first 2 wk (67,75), and others showing the majority of deaths after the first 2 wk (59,89,135). These variations reflect a variety of influences including percentage of very ill patients referred to a reporting hospital compared to patients admitted directly.…”

Section: Overview Of Acute Pancreatitismentioning

confidence: 98%

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,662

980

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“…Ranson and Glasgow scores, although simpler to use in a clinical setting, do not achieve satisfactory sensitivity, specificity or predictive values [15]. Individual factors such as obesity, alcohol, smoking, specific organ failure and high age have also been associated with an increased risk of a severe acute pancreatitis [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

The Risk Factors of Intensive Care Unit Admittance during First Attack of Acute Pancreatitis

Dale¹,

Omdal²,

Lie³

et al. 2012

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Background: A proportion of patients with acute pancreatitis develop severe organ dysfunction requiring admittance in an intensive care unit. Patient characteristics associated with ICU admittance were evaluated in this consecutive series of patients. Methods: The clinical course of patients with first attack of acute pancreatitis in urban Norway between 01.01.1996 and 31.12.2006 was reviewed. Patient characteristics, comorbidity, pre hospital delay and likely aetiology of acute pancreatitis were analysed as risk factors for ICU admittance. Results: This study includes 565 patients, 299 women and 266 men (p = 0.089), with a median age of 60 years (range: 17 -98). 50 (9%) of the patients were admitted to the ICU. Men were more at risk than women for ICU admittance (OR 2.34; 95% CI: 1.27 -4.32). Patients with alcohol associated pancreatitis (OR 5.94; 95%, CI: 2.61 -13.53), miscellaneous aetiologies (OR: 2.81, 95% CI: 1.02 -7.73) and non-assessed aetiology (OR 2.71, 95%, CI: 1.26 -5.82) were more at risk of ICU admittance than patients with bile stones associated pancreatitis. Pre hospital delay increased the risk of ICU admittance amongst patients with alcohol associated pancreatitis (OR 4.23; 95%, CI: 1.11 -16.18). Two comorbid conditions conveyed increased risk (OR 8.78; 95%,). The case fatality rate was 24% in the ICU and 1.6% in the ward (OR 20.01, 95% CI: 7.71 -51.93). Conclusions: Aetiology of acute pancreatitis, especially alcohol, pre-hospital delay and male gender are associated with increased of risk of ICU admittance and increased fatality rate during first attack of AP.

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Factors Predicting Mortality in Severe Acute Pancreatitis

Cited by 106 publications

References 25 publications

Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?

Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?

Practice Guidelines in Acute Pancreatitis

The Risk Factors of Intensive Care Unit Admittance during First Attack of Acute Pancreatitis

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