Coexistence of exocrine and endocrine pancreatic insufficiency in chronic pancreatitis. Our experience 2001-2014

Abstract

s / Pancreatology 2 Family and Community Medicine Teaching Unit, EVES, Valencia, Spain Background: Acute pancreatitis (AP) is a common cause of hospital admissionwith increasing incidence inwestern countries. Clinical course is usually unpredictable at the onset of symptoms and hence, early detection of severe cases is critical in order to encourage strict monitoring and aggressive treatment strategies, as well as referral to an intensive care unit. Objectives: To identify factors predicting moderately-severe and severe AP (MSAP, SAP) on admission, according to the 2012 Atlanta classification. Methods: Prospective study including 97 patients diagnosed with AP that were admitted into our hospital during a 12 month period (January 2014 e December 2014). Clinical, laboratory and imaging variables were recorded, in addition to parameters such as: onset of organ failure (OF), presence of pancreatic necrosis (PN) or infected pancreatic necrosis (IPN), and requirement of either percutaneous drainage or surgery. A logistic regression model was employed, using odds ratio (OR) as a measure of association and the area under the ROC curve (AUC) to determine discrimination. 95% confidence intervals (CI) were calculated for each test. Results: 54 patients were male (55.7%) and mean age was 64.6 years. 77 cases of APwere interstitial (79.4%) and 20were necrotizing (20.6%), ofwhich 6 developed IPN (6.2%), 11 developed OF (11.3%) and 7 deceased (7.2%). 23 cases were classified as a MSAP or SAP, both of which were found to be independently associatedwith the following: hypotension [(SBP 90mg/L (OR 4.8; 95%IC 1.4e17.3; p1⁄40.01), WBC count>17000/mL (OR 5.0; 95%IC 1.5 e 15.5; p1⁄40.008) and hematocrit >45% (OR 5.8; 95%IC 1.7 e 19.6; p1⁄40.004). Multivariate analysis revealed adequate discriminatory power (AUC 0.85; 95%IC 0.78 e 0.93). Conclusions: The presence on admission of hypotension, increased CRP, WBC count or hematocrit are all independent predictors of poor clinical outcome and should therefore prompt strict monitoring of these patients.