Prediction of Self-Limited Acute Pancreatitis Cases at Admission to Emergency Unit

Abstract

Background: While acute pancreatitis (AP) resolves spontaneously with supportive treatment in most patients, it may be life-threatening. Predicting the disease severity at onset dictates the management strategy. We aimed to define the patients with mild pancreatitis who may be considered for outpatient management with significant cost-savings. Materials and Methods: This prospective observational study included 180 patients with mild AP according to the harmless acute pancreatitis score (HAPS) and Imrie score. The relationships of biochemical parameters with the changes in the Balthazar score and clinical course were examined. Results: The study included 180 patients (111 females, 69 males; mean age: 53.9 ± 17.2 years; range: 17–92 years). The etiology was biliary in 118 (65%) patients and remained undetermined in 38 (21.1%) patients. Computed tomography (CT) performed within the first 12 h revealed mild and moderate AP in 159 (88.3%) and 21 (11.7%) patients, respectively. CT repeated at 72 h revealed mild, moderate, and severe AP in 155 (86.1%), 24 (13.3%), and 1 (0.6%) patients, respectively. Comparisons between stages A + B + C and D + E showed significant differences in the amylase levels on day 1 and 3, and in C-reactive protein on day 3. Also, in stage D and E disease, narcotic analgesic intake, oral intake onset time, and pain were significantly higher. Conclusion: There were no significant changes in the CT findings of patients with mild AP at 12 and 72 h. Most patients (n = 179; 99.4%) recovered uneventfully. Patients with mild pancreatitis according to the HAPS and Imrie scores can be considered for outpatient management. The recovery is longer in stage D and E disease.

C-Reactive Protein as a Predictor of Complicated Acute Pancreatitis: Reality or a Myth?

“…We have not assessed the validity and reliability of that system, however, we feel that any patient with AP having NL ratio of less than 4.7 at admission, Glasgow score less than 2, CRP of less than 150-190 at 48 hours, and rise in CRP of less than 90 in 48 hours will have more than 80% chances of not developing the complicated acute pancreatitis. The clinical implication is that such patients can be discharged earlier or can be managed on ambulatory care basis [24]. In patients with high suspicion of the severity of the disease, a CT scan should be performed and MCTSI should be calculated.…”

Optimal timing of contrast‑enhanced computed tomography in an evaluation of severe acute pancreatitis‑associated complications

“…In a previous study, Kayar et al (29) assessed 180 patients with AP and mild pancreatitis with the aim of identifying patients who should be considered for home-monitoring. The results from a previous study indicated that there were no significant alterations in the CT findings of mild AP patients at 12 and 72 h (29). Another previous study assessed the role of low molecular weight heparin in the management of patients with moderately severe AP (MSAP) (30).…”

Interventional strategies in infected necrotizing pancreatitis: Indications, timing, and outcomes

“…During this time, a pro-inflammatory sterile response occurs, which can lead to systemic inflammatory response syndrome (SIRS)[ 13 ]. Nevertheless, AP is self-limited in more than 80% of patients, and treatment in the early phase consists of supportive care instead of a curative intervention[ 14 ]. However, necrosis and acute necrotic collection (ANC) can occur in the late phase.…”