475p Prognostic Value of Blood Urea Nitrogen (BUN) in the Early Assessment of Acute Pancreatitis: An International Study

Abstract

G A A b st ra ct s mortality during admission and 3 months follow-up. Secondary endpoints included other morbidity and total costs at 6 months follow-up. RESULTS: Infected necrosis was present in 81 patients (92%). The primary endpoint occurred in 31 of 45 patients (69%) assigned to open necrosectomy and in 17 of 43 patients (40%) assigned to the step-up approach (risk ratio 0.57; 95% confidence interval 0.38 to 0.87; P=0.006). In the step-up approach group, 35% of patients were successfully treated with percutaneous drainage only and did not require necrosectomy. New onset multiple organ failure occurred less often in the stepup approach group (12% versus 40%; P=0.002). At 6 months follow-up, patients in the step-up approach group had a lower rate of incisional hernias (7% versus 24%; P=0.03), use of pancreatic enzymes (7% versus 33%; P=0.002) and new onset diabetes (16% versus 38%; P=0.02). Mean total costs per patient were $15,963 (12%) lower in the step-up approach group. CONCLUSIONS: A minimally invasive step-up approach, as compared to open necrosectomy, reduced the rate of the composite endpoint of major morbidity and mortality as well as long-term morbidity and costs in patients with (suspected) infected necrotizing pancreatitis. In these patients, percutaneous drainage should be considered as the first step of treatment.