Abstract
BackgroundThe severity of acute alcohol-related pancreatitis (AAP) with alcohol withdrawal syndrome (AWS) has not been studied. Electrocardiogram (ECG) has not been used as a predictor of severity in patients with AWS and acute pancreatitis.ObjectivesThe study aimed to determine whether the ECG heart rate (HR) could predict the severity of AAP; secondarily, whether AWS influenced the severity of AAP based on Acute Physiology and Chronic Health Evaluation (APACHE) II and Bedside Index for Severity in Acute Pancreatitis (BISAP).MethodsDemographics, comorbid illnesses, AWS, biochemistry, ECG, arterial blood gases, and CT findings were noted in patients with AAP. The severity of pancreatitis was scored into mild, moderate, and severe based on CT. BISAP, APACHE II, and ECG heart rate-APACHE (E-APACHE) were compared in patients with and without AWS. A receiver operating characteristic curve was used to find the best predictor of severity.ResultsAmong 138 patients (M=128), 94 had AWS. ECG changes (≥1) were seen in 50%. Patients with AWS were younger, had consumed alcohol for a shorter duration, had higher systemic inflammatory response syndrome (SIRS), APACHE II, and E-APACHE II scores. APACHE II and E-APACHE II correlated significantly with severity grading, HR, alcohol duration, and AWS. HR was the best predictor of severe pancreatitis; E-APACHE was the best predictor for moderately severe pancreatitis.ConclusionsMostly, AAP appears to be mild; >2/3rds have AWS. ECG findings were seen in 50%. HR has not been previously studied in patients with both AAP and AWS and is an easy and inexpensive test to predict the severity of pancreatitis in this cohort.
Highlights
Acute pancreatitis is an inflammatory disorder characterized by acinar cell destruction whose diagnosis is based on the presence of any two of the following: characteristic abdominal pain, elevated lipase or amylase, and findings on abdominal imaging [1]
The study aimed to determine whether the ECG heart rate (HR) could predict the severity of alcohol-related pancreatitis (AAP); secondarily, whether alcohol withdrawal syndrome (AWS) influenced the severity of AAP based on Acute Physiology and Chronic Health Evaluation (APACHE) II and Bedside Index for Severity in Acute Pancreatitis (BISAP)
HR was the best predictor of severe pancreatitis; EAPACHE was the best predictor for moderately severe pancreatitis
Summary
Acute pancreatitis is an inflammatory disorder characterized by acinar cell destruction whose diagnosis is based on the presence of any two of the following: characteristic abdominal pain, elevated lipase or amylase (three times normal), and findings on abdominal imaging [1]. Tachycardia, altered mental status, vomiting, and electrolyte disturbances that are seen in AWS may mimic the clinical features or complications of acute pancreatitis. One study of severe acute pancreatitis was available wherein heart rate variability was described to predict complications such as infected necrosis [4]. The severity of acute alcohol-related pancreatitis (AAP) with alcohol withdrawal syndrome (AWS) has not been studied. Electrocardiogram (ECG) has not been used as a predictor of severity in patients with AWS and acute pancreatitis
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