Pleuropulmonary pathologies in the early phase of acute pancreatitis correlate with disease severity.

Ina Luiken,Richard Brill,Jakob Garbe,Lucas Ilzarbe,Jonas Rosendahl,Alexandra Dimova,Stephan Eisenmann,Povilas Ignatavicius,Johannes Dober,Sara Regnér,Marko Damm,Anne K Penttilä,Walter A Wohlgemuth,Hanna Sternby,Patrick Michl,Peeter Koiva,Robert C Verdonk,Ulrich Wellner

doi:10.1371/journal.pone.0263739

Abstract

BackgroundRespiratory failure worsens the outcome of acute pancreatitis (AP) and underlying factors might be early detectable.AimsTo evaluate the prevalence and prognostic relevance of early pleuropulmonary pathologies and pre-existing chronic lung diseases (CLD) in AP patients.MethodsMulticentre retrospective cohort study. Caudal sections of the thorax derived from abdominal contrast enhanced computed tomography (CECT) performed in the early phase of AP were assessed. Independent predictors of severe AP were identified by binary logistic regression analysis. A one-year survival analysis using Kaplan-Meier curves and log rank test was performed.Results358 patients were analysed, finding pleuropulmonary pathologies in 81%. CECTs were performed with a median of 2 days (IQR 1–3) after admission. Multivariable analysis identified moderate to severe or bilateral pleural effusions (PEs) (OR = 4.16, 95%CI 2.05–8.45, p<0.001) and pre-existing CLD (OR = 2.93, 95%CI 1.17–7.32, p = 0.022) as independent predictors of severe AP. Log rank test showed a significantly worse one-year survival in patients with bilateral compared to unilateral PEs in a subgroup.ConclusionsIncreasing awareness of the prognostic impact of large and bilateral PEs and pre-existing CLD could facilitate the identification of patients at high risk for severe AP in the early phase and thus improve their prognosis.

Highlights

Acute pancreatitis (AP) is one of the most frequent reasons for hospital admissions due to gastrointestinal diseases with increasing incidence and remains to be a major clinical and economic burden for health care systems in industrialised countries [1–3].Three severity grades depending on the development and duration of organ failure and local or systemic complications are distinguished according to the revised Atlanta Classification
Multivariable analysis identified moderate to severe or bilateral pleural effusions (PEs) (OR = 4.16, 95%CI 2.05–8.45, p
Increasing awareness of the prognostic impact of large and bilateral PEs and pre-existing CLD could facilitate the identification of patients at high risk for severe acute pancreatitis (AP) in the early phase and improve their prognosis

Summary

Methods

Caudal sections of the thorax derived from abdominal contrast enhanced computed tomography (CECT) performed in the early phase of AP were assessed. Independent predictors of severe AP were identified by binary logistic regression analysis. A one-year survival analysis using Kaplan-Meier curves and log rank test was performed

Results

Introduction

Discussion