A PROSPECTIVE LONGITUDINAL OBSERVATIONAL STUDY ON ACUTE PANCREATITIS: FACTORS INFLUENCING MORBIDITY AND MORTALITY

Abstract

Background: Acute pancreatitis presents a broad clinical spectrum ranging from cases so mild that symptoms abate before the diagnosis is actively pursued, to cases which progress rapidly to multisystem failure and eventual demise of patient despite current mode of therapy. Aims And Objectives: To determine factors related to disease severity, mortality and morbidity in acute pancreatitis. Materials And Methods: Study design: A prospective longitudinal observational study. Study area: Ramakrishna Mission Seva Pratishthan Hospital, Kolkata. Study period: April 2017 to March 2018 Sample size: 76 patients diagnosed with acute pancreatitis after admission. All patients were subjected to a thorough history taking, clinical examination, routine blood tests and imaging and monitoring of vitals. Patients with complications like sepsis, shock or organ failure was treated in ICU, with invasive and non-invasive monitoring. Thorough IV uid resuscitation and appropriate analgesics were used with conservative management. Initially put in NPM, started with enteral feeding when ileus subsided or parenteral feeding at appropriate time if clinically unstable. ERCP was done followed by open/laparoscopic cholecystectomy in gallstone pancreatitis patients. Results: The overall mortality for the study group was 11.8 % and the morbidity rate was 31.5 %. The mortality for male was greater than that for female. The mortality for patients over 50 years of age was greater than that of patients below 50 years of age. The mean duration of hospitalization for the total study group was 14 days and it was found to be higher in male (18 days) than for female (10 days). The mortality for this idiopathic group(n=4, 16.67%) was found to be higher than that for the alcoholic group(n=3, 13.6%) and those with biliary tract disease(n=2, 6.67%), whereas morbidity of the alcoholic group(n=12, 40%) was found higher than the idiopathic group(n=8, 33.3%) and biliary disease group(n=4, 18.1%). Mortality rate in patients with pseudocyst was 10%, 50% in pancreatic abscess, 42.8% in circulatory failure patients, 50% in renal failure patients and 75% in respiratory failure patients. Conclusion: Despite earlier recognition and appropriate care the morbidity and mortality rates have remained quite high in cases of severe attack of acute pancreatitis