Predictors of Critical Acute Pancreatitis

Abstract

Critical acute pancreatitis (CAP) has recently emerged as the most ominous severity category of acute pancreatitis (AP). As such there have been no studies specifically designed to evaluate predictors of CAP. In this study, we aimed to evaluate the accuracy of 4 parameters (Acute Physiology and Chronic Health Evaluation [APACHE] II score, C-reactive protein [CRP], D-dimer, and intra-abdominal pressure [IAP]) for predicting CAP early after hospital admission. During the study period, data on patients with AP were prospectively collected and D-dimer, CRP, and IAP levels were measured using standard methods at admission whereas the APACHE II score was calculated within 24 hours of hospital admission. The receiver-operating characteristic (ROC) curve analysis was applied and the likelihood ratios were calculated to evaluate the predictive accuracy. A total of 173 consecutive patients were included in the analysis and 47 (27%) of them developed CAP. The overall hospital mortality was 11% (19 of 173). APACHE II score ≥11 and IAP ≥13 mm Hg showed significantly better overall predictive accuracy than D-dimer and CRP (area under the ROC curve—0.94 and 0.92 vs 0.815 and 0.667, correspondingly). The positive likelihood ratio of APACHE II score is excellent (9.9) but of IAP is moderate (4.2). The latter can be improved by adding CRP (5.8). In conclusion, of the parameters studied, APACHE II score and IAP are the best available predictors of CAP within 24 hours of hospital admission. Given that APACHE II score is rather cumbersome, the combination of IAP and CRP appears to be the most practical way to predict critical course of AP early after hospital admission.

Rhubarb vs. glycerin enema for treatment of critically ill patients with intra-abdominal hypertension

“…APACHE II, CRP and IAP levels are good predictors of disease severity in critical acute pancreatitis (22). Previous results indicated that APACHE II and SOFA scores were positively associated with the severity of IAP (20).…”

Predictors of Early Surgical Intervention in Patients With Severe Acute Pancreatitis

“…ст.) [6,9,16]. Другие современные маркеры тяжести и прогноза ТОП включают амилоид А, трип-син-активированный пептид [14,17], сывороточный ферритин [3] и цитокины -IL-6, IL-12 и ангиопоэтин-2 плазмы.…”

Acute Pancreatitis, Actualization and Evidence Based Management

“…This was superior to both Ranson and Glasgow scores at 48 h. Although the APACHE II scoring system has gained some recognition for its performance and fl exibility, the complexity of the system hinders its everyday use [18]. higher mortality by each 1mmHg of PIA>12mmHg [9][10][11][12].…”

“…If it is not accomplished, acinar cells would develop ischemia and necrosis secondary to hipoperfusion [7]. Persistent cytokines release by necrotic tissue would increase vascular permeability favoring pulmonary effusion and respiratory distress, hypovolemia, hypotension, acute renal failure, intestinal edema and intra-abdominal hypertension [8,9].…”

“…Intra-abdominal hypertension (IAH) and abdominal compartmental syndrome (ACS) can be developed in almost 35% of cases of severe pancreatitis, secondary to intestinal edema, ascites and retroperitoneal liquid collections, sometimes precipitated by an aggressive fl uid therapy. In fact, actually IAH and ACS are considered a severity parameter [9][10][11][12][13].…”